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# Calcium Gluconate
## Overview
Calcium gluconate is a calcium salt providing elemental calcium. It is preferred over calcium chloride for peripheral intravenous administration because it is less irritating to tissues, though still carries a risk of extravasation. Contains 93 mg of elemental calcium per 1 gram of calcium gluconate.
## Primary Indications
* Hypocalcemia
* Hyperkalemia-associated cardiac membrane stabilization
* Calcium channel blocker overdose
* Magnesium toxicity
## Adult Dosing
* **Hypocalcemia:** 1–2 grams administered IV slowly (max 200 mg/min). May repeat every 4–6 hours as needed based on serum levels.
* **Hyperkalemia/Cardiac Stabilization:** 1–2 grams (10–20 mL of 10% solution) IV over 5–10 minutes.
* **Ca Channel Blocker Overdose/Magnesium Toxicity:** 1–3 grams IV slowly; may follow with a continuous infusion if required by clinical status.
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose IV; may repeat every 6 hours.
* **Hyperkalemia/Emergency:** 50–100 mg/kg/dose IV over 5–10 minutes.
* *Note: Always verify specific pediatric protocols based on age/gestational status, as dosing varies significantly in neonates.*
## Dose Adjustments
* **Renal Impairment:** Use with caution in patients with chronic kidney disease; no fixed dose reduction, but monitor serum calcium frequently to avoid hypercalcemia.
## Contraindications
* Ventricular fibrillation (during cardiac resuscitation).
* Hypercalcemia.
* Digitalis toxicity (calcium may precipitate severe arrhythmias).
## Adverse Effects
* **Common:** Peripheral vasodilation, transient hypotension, bradycardia, metallic taste.
* **Serious:** Extravasation (tissue necrosis/sloughing), cardiac arrhythmias (if infused too rapidly), and hypercalcemia.
## Key Drug Interactions
* **Digoxin:** Calcium increases the risk of digitalis toxicity; use with extreme caution or avoid.
* **Ceftriaxone:** Physical incompatibility. Do not mix or administer via the same Y-site in IV lines; can form fatal calcium-ceftriaxone precipitates in neonates and adults.
* **Phosphate/Bicarbonate:** Precipitation may occur if mixed in IV fluids.
## Monitoring
* **Serum Calcium:** Monitor total and ionized calcium levels.
* **Cardiac:** Continuous ECG monitoring during rapid IV administration to detect bradycardia or arrhythmia.
* **Site:** Palpate IV site frequently for signs of infiltration/extravasation.
## Clinical Pearls
* **Administration:** Infuse slowly. Rapid infusion can cause hypotension, cardiac arrest, and vasodilation.
* **Extravasation:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor for tissue damage; consider hyaluronidase injections if indicated by institutional policy.
* **Elemental Calcium:** Remember 1 gram Ca-gluconate $\neq$ 1 gram elemental calcium (only ~93 mg elemental Ca per gram).
* **Local Policy:** Always check hospital-specific protocols for infusion concentrations and rate limitations, particularly for pediatric and neonatal populations.
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*Disclaimer: This information is for educational purposes only. Dosing, contraindications, and drug interactions can change. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering medications.*
