Calcium%252525252525252525252525252525252520gluconate

# Calcium gluconate ## Overview Calcium gluconate is a parenteral calcium salt used to replenish calcium levels. It provides approximately 93 mg (4.65 mEq) of elemental calcium per 1 gram. It is preferred over calcium chloride for peripheral administration due to lower risk of tissue necrosis if extravasation occurs. ## Primary Indications * Acute symptomatic hypocalcemia. * Hyperkalemia-associated cardiac toxicity (membrane stabilization). * Magnesium toxicity. * Calcium channel blocker or hydrofluoric acid toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 grams (IV) administered over 15–30 minutes. May repeat every 6 hours as needed based on serum calcium levels. * **Hyperkalemia / Cardiac Protection:** 1–2 grams (IV) over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist. * **Max Rate:** Do not exceed 200 mg/minute (approx. 2 mL/min of 10% solution) to prevent bradycardia/arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (infused over 15–30 minutes); repeat every 6 hours if necessary. * **Cardiac Protection/Hyperkalemia:** 50–100 mg/kg/dose (max 2 grams per dose) IV push over 5–10 minutes. * **Note:** Dosing varies by institutional protocol; verify with local guidelines for neonates and pediatric intensive care units. ## Dose Adjustments * **Renal Impairment:** Use with caution in patients with chronic kidney disease; ensure serum calcium is monitored closely to avoid toxicity. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (increased risk of severe arrhythmias). * Serious arrhythmias (unless correcting hyperkalemia or calcium-channel blocker toxicity). ## Adverse Effects * **Common:** Hypotension, bradycardia (if infused too rapidly), peripheral vasodilation, chalky taste, tingling. * **Serious:** Tissue necrosis/sloughing (if extravasation occurs), cardiac arrhythmias, hypercalcemia. ## Key Drug Interactions * **Digoxin:** Calcium can potentiate the effects and toxicity of digitalis; avoid use in patients receiving digoxin unless indicated for life-threatening hyperkalemia. * **Ceftriaxone:** Physical incompatibility; potential for fatal precipitation in neonates. Do not administer IV calcium-containing products within 48 hours of ceftriaxone in neonates (≤28 days). * **Phosphate-containing solutions:** High risk of calcium-phosphate precipitate formation. Flush lines thoroughly between infusions. ## Monitoring * **Serum Parameters:** Ionized calcium is the gold standard; serum total calcium. * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Site:** Assess IV site frequently for signs of extravasation. ## Clinical Pearls * **Administration:** Ensure IV patency. If extravasation occurs, stop the infusion immediately and consult wound care/plastic surgery protocols. * **Efficiency:** Calcium gluconate provides less elemental calcium than calcium chloride (1g gluconate ≈ 93mg Ca; 1g chloride ≈ 272mg Ca) but is safer for peripheral veins. * **Compatibility:** Highly prone to precipitation with many drugs; use a dedicated line or flush thoroughly. *** *Educational Disclaimer: This information is for educational purposes only and does not constitute medical advice. Dosing, compatibility, and safety protocols vary by institution. Always verify dosages and compatibility with current hospital protocols, package inserts, and clinical pharmacists before administration.*