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# Calcium Gluconate
## Overview
Calcium gluconate is an injectable calcium salt providing elemental calcium. It is preferred over calcium chloride for peripheral administration due to lower risk of tissue necrosis. Contains 93 mg of elemental calcium per 1 gram of calcium gluconate (approx. 4.65 mEq).
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemia (cardioprotection, does not lower serum potassium).
* Calcium channel blocker or magnesium sulfate toxicity.
* Cardiac resuscitation (in presence of hyperkalemia, hypocalcemia, or CCB overdose).
## Adult Dosing
* **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV slow bolus; may repeat or follow with continuous infusion (0.5–2 mg/kg/hr elemental calcium).
* **Hyperkalemia/Cardiac Emergencies:** 1–2 grams (10–20 mL of 10% solution) IV push over 5–10 minutes. May repeat every 10 minutes if ECG changes persist.
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg (1–2 mL/kg of 10% solution) per dose IV slowly over 10–20 minutes.
* **Emergency/Cardiac:** 60–100 mg/kg (0.6–1 mL/kg of 10% solution) per dose IV push over 5–10 minutes.
* *Note:* Exact pediatric dosing varies by institutional protocol and clinical status; consult local guidelines.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium levels frequently to avoid hypercalcemia. No standardized dose reduction, but adjust based on clinical response.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation.
* Digitalis toxicity (relative contraindication: calcium can precipitate severe arrhythmias; administer with extreme caution if mandatory).
## Adverse Effects
* **Common:** Hypotension, bradycardia (if administered too rapidly), peripheral vasodilation, localized burning at the injection site.
* **Serious:** Extravasation causing tissue necrosis/sloughing, cardiac arrhythmias, syncope, hypercalcemia.
## Key Drug Interactions
* **Digoxin:** Increases risk of digoxin toxicity (calcium-induced synergistic cardiotoxicity).
* **Ceftriaxone:** Physical incompatibility (IV precipitation); do not mix or administer via the same line (flush thoroughly between).
* **Tetracyclines/Fluoroquinolones:** Calcium can chelate these drugs, reducing their absorption/efficacy.
## Monitoring
* **ECG:** During rapid infusion to detect bradycardia or arrhythmias.
* **Serum Calcium:** Check ionized calcium levels prior to and following dose administration.
* **Site assessment:** Monitor for signs of extravasation (pain, swelling, erythema).
## Clinical Pearls
* **Administration:** Slow IV push (not exceeding 200 mg/min) to prevent cardiac arrest.
* **Extravasation:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor. In severe cases, sodium thiosulfate may be considered (consult institutional protocols).
* **Calcium Gluconate vs. Chloride:** 1 g of calcium gluconate provides ~93 mg elemental calcium; 1 g of calcium chloride provides ~272 mg. They are not weight-equivalent for dosing.
* **Compatibility:** Calcium salts precipitate if mixed with phosphate-containing solutions or sodium bicarbonate. Use separate lines or flush thoroughly.
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**Disclaimer:** This information is for educational purposes only. Dosing protocols may vary by institution. Always verify dosages and compatibility with current local guidelines, clinical software, and official prescribing information before administration.
