Calcium%2525252525252525252525252525252520gluconate

# Calcium gluconate ## Overview Calcium gluconate is a calcium salt providing elemental calcium. It is primarily used for the treatment of hypocalcemia and as an adjunct in hyperkalemia-associated cardiac membrane stabilization. It contains 90 mg of elemental calcium per 1 gram of calcium gluconate. It is preferred over calcium chloride for peripheral administration due to reduced risk of tissue necrosis. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia. * Adjunct in cardiac resuscitation (if hyperkalemia or hypocalcemia is suspected). * Magnesium toxicity (antidote). ## Adult Dosing * **Hypocalcemia:** 1–2 g (10–20 mL of 10% solution) IV; may repeat every 6 hours or follow with a continuous infusion. * **Hyperkalemia (Cardioprotection):** 1–2 g (10–20 mL of 10% solution) IV push over 5–10 minutes. May repeat if ECG changes persist. * **Administration:** Infuse at a rate not to exceed 200 mg/minute (2 mL/minute of 10% solution). ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg/dose of 10% solution) IV slow push over 10–20 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose IV over 5–10 minutes. * *Note: Dosing should be individualized based on ionized calcium levels and clinical parameters.* ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but use with caution; monitor serum calcium levels frequently to avoid hypercalcemia. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation (during CPR, generally avoided). * Hypercalcemia. * Digitalis toxicity (calcium may increase cardiac irritability and precipitate arrhythmias). * History of calcium nephrolithiasis (relative). ## Adverse Effects * **Common:** Hypotension, bradycardia (if infused too rapidly), vasodilation, tingling/flushing, metallic taste. * **Serious:** Cardiac arrhythmias, syncope, tissue necrosis/sloughing (if extravasated). ## Key Drug Interactions * **Digoxin:** Calcium synergizes with digitalis; risk of fatal arrhythmias. Avoid/use extreme caution. * **Ceftriaxone:** Calcium-ceftriaxone precipitation can occur in the lungs and kidneys, particularly in neonates. Do not administer IV calcium in the same line within 48 hours of ceftriaxone in neonates. * **Phosphates/Carbonates:** Potential for precipitation when mixed in the same IV line. ## Monitoring * **ECG:** Mandatory during IV administration (monitor for bradycardia, QT shortening, or heart block). * **Laboratory:** Serum ionized calcium (preferred) or total serum calcium, serum potassium. * **Local Site:** Inspect for signs of extravasation (pain, swelling, erythema). ## Clinical Pearls * **Peripheral vs Central:** Calcium gluconate is less irritating to veins than calcium chloride but extravasation can still cause tissue necrosis. If extravasation occurs, stop the infusion immediately and consider hyaluronidase infiltration. * **Compatibility:** Highly incompatible with many medications. Flush line thoroughly with 0.9% NaCl before and after administration. * **Local Protocols:** Institutional protocols for "Calcium Gluconate vs. Calcium Chloride" must be followed, especially in emergency/code settings, as the elemental calcium content differs significantly (1g of IV calcium gluconate ≈ 0.34g of IV calcium chloride). *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution. Always verify dosages, contraindications, and drug compatibility using current hospital protocols, electronic medical records, or up-to-date pharmaceutical references (e.g., Lexicomp, Micromedex) before prescribing or administering medication.