Calcium%2525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an intravenous (IV) calcium salt used to manage hypocalcemia and hyperkalemia. It provides 90 mg of elemental calcium per 1 gram of calcium gluconate (approximately 4.65 mEq of calcium). It is generally preferred over calcium chloride for peripheral administration as it is less irritating to veins. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia (does not lower potassium levels). * Magnesium toxicity (antidote). * Calcium channel blocker overdose (adjunctive therapy). ## Adult Dosing * **Hypocalcemia:** 1–2 grams IV slow push over 5–10 minutes. May repeat every 4–6 hours or follow with a continuous infusion titrated to serum calcium levels. * **Hyperkalemia/Magnesium Toxicity:** 1–2 grams IV over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Maximum Rate:** Should not exceed 200 mg/minute (2 mL/minute of 10% solution) to prevent cardiac arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (infused slowly over 10–20 minutes); may repeat every 6 hours as needed. * **Cardiac Emergency:** 100 mg/kg/dose (max 2 grams). * **Note:** Always verify specific institution protocols for neonates and pediatrics, as dosing varies significantly by age and indication. ## Dose Adjustments * **Renal Impairment:** Use with caution; monitor serum ionized calcium closely. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Hypercalcemia. * Ventricular fibrillation (during resuscitation, calcium is generally avoided unless hyperkalemia is the suspected cause). * Digitalis toxicity (calcium can potentiate cardiac toxicity). ## Adverse Effects * **Common:** Hypotension, bradycardia, arrhythmias (if infused too rapidly), vasodilation, peripheral tingling. * **Rare:** Tissue necrosis if extravasation occurs, metastatic calcification. ## Key Drug Interactions * **Digoxin:** Increases risk of severe arrhythmias. * **Ceftriaxone:** Potential for fatal precipitation in IV lines (do not mix in the same line; flush lines thoroughly between doses). * **Tetracyclines/Fluoroquinolones:** May form insoluble complexes; advise separation of administration. ## Monitoring * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Labs:** Serum ionized calcium levels are preferred over total calcium; monitor potassium (if treating hyperkalemia). * **Site:** Palpate IV site frequently; ensure patency to prevent extravasation. ## Clinical Pearls * **Extravasation:** High risk of tissue necrosis; if it occurs, stop infusion immediately, elevate limb, and consider hyaluronidase injections. * **Compatibility:** Highly incompatible with many drugs (especially phosphates and bicarbonates, which cause precipitation). Flush lines well. * **Dosing clarification:** 1 gram of calcium gluconate (10 mL of 10% solution) provides significantly less elemental calcium than 1 gram of calcium chloride (approx. 270 mg elemental calcium). Ensure the correct salt is specified in the order. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution. Always verify specific dosing, compatibilities, and contraindications by consulting current institutional protocols, your clinical pharmacist, and the manufacturer’s package insert before prescribing or administering medication.