Calcium%25252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an injectable 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 calcium). ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac stabilization in hyperkalemia (to antagonize cardiac membrane effects). * Calcium channel blocker overdose or magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV administered over 10–20 minutes. May repeat every 4–6 hours as needed. * **Hyperkalemia (Cardioprotection):** 1–2 grams (10–20 mL of 10% solution) IV push over 5–10 minutes. May repeat if ECG changes persist. * **Maximum Rate:** Should not exceed 200 mg/min (2 mL/min of 10% solution) to prevent bradycardia/arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (1–2 mL/kg/dose of 10% solution) IV. Administer slowly over 10–20 minutes. May repeat every 6 hours or convert to continuous infusion. * **Hyperkalemia:** 50–100 mg/kg/dose (0.5–1 mL/kg/dose of 10% solution) IV push over 5–10 minutes. * *Note: Always verify dose based on patient-specific weight and local institutional protocols.* ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but monitor ionized calcium closely as the risk of hypercalcemia is higher. * **Hepatic Impairment:** No adjustments required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (calcium can increase myocardial irritability and precipitate digitalis-induced arrhythmias). ## Adverse Effects * **Local:** Tissue necrosis and sloughing if extravasation occurs. * **Systemic:** Hypotension, bradycardia, arrhythmias (if infused too rapidly), and syncope. * **Gastrointestinal:** Chalky taste, nausea, or vomiting. ## Key Drug Interactions * **Digoxin:** Increases risk of severe arrhythmias. Use extreme caution or avoid. * **Ceftriaxone:** Physical incompatibility. Ceftriaxone-calcium precipitates in the lungs and kidneys; do not co-administer or use in the same IV line/Y-site (flush lines thoroughly or use separate sites). * **Phosphate-containing solutions:** Risk of precipitation. ## Monitoring * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Laboratory:** Serum ionized calcium, total calcium, and electrolytes (potassium, phosphate, magnesium). * **Site:** Carefully monitor the peripheral IV site for extravasation (calcium gluconate is less of an irritant than calcium chloride but still carries risk). ## Clinical Pearls * **Calcium Chloride vs. Gluconate:** Calcium chloride provides three times the elemental calcium of gluconate (270 mg vs 90 mg/g). Gluconate is preferred for peripheral administration as it is less likely to cause tissue necrosis if extravasated. * **Administration:** If local skin damage occurs, discontinue the infusion immediately. * **Correction:** Always correct or "adjust" total serum calcium for low albumin levels using the formula: *Corrected Calcium = Measured Total Calcium + 0.8 * (4.0 - Serum Albumin)*. *** **Educational Disclaimer:** This information is for educational purposes only. Always verify doses, contraindications, and compatibility with local institutional protocols, current package inserts, and clinical decision support systems (e.g., Lexicomp, Micromedex) before prescribing or administering medication.