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# Calcium Gluconate
## Overview
Calcium gluconate is a calcium salt providing elemental calcium (approx. 90 mg elemental Ca per 1 g of calcium gluconate). It is the preferred agent for intravenous administration due to lower potential for tissue necrosis compared to calcium chloride if extravasation occurs.
## Primary Indications
* Hypocalcemia (symptomatic).
* Hyperkalemia-associated cardiac membrane stabilization.
* Magnesium toxicity.
* Calcium channel blocker overdose.
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infused over 10–20 minutes. May repeat every 4–6 hours as needed based on serum levels.
* **Hyperkalemia (Cardioprotection):** 1–2 g IV (push or over 5–10 minutes). Repeat every 5–10 minutes if ECG changes persist.
* **Administration:** Max rate 200 mg/min (to avoid bradycardia/hypotension).
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose (max 2 g) IV infused over 30–60 minutes.
* **Hyperkalemia (Cardioprotection):** 50–100 mg/kg/dose (max 2 g) IV.
* **Note:** Dosing varies significantly by institutional protocol; confirm pediatric concentration and infusion rate with weight-based orders.
## Dose Adjustments
* **Renal Impairment:** No specific reduction required, but use with extreme caution; monitor for hypercalcemia.
* **Hepatic Impairment:** No adjustment required.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation.
* Concurrent administration with ceftriaxone in neonates (≤28 days) due to risk of fatal calcium-ceftriaxone precipitate in lungs/kidneys.
## Adverse Effects
* **Cardiovascular:** Bradycardia, arrhythmias, hypotension (with rapid infusion).
* **Local:** Vein irritation, tissue necrosis (if extravasation occurs).
* **Dermatological:** Flushing, burning sensation.
## Key Drug Interactions
* **Digoxin:** Calcium can potentiate digoxin-induced arrhythmias; monitor closely.
* **Ceftriaxone:** Physical incompatibility (precipitate formation); never mix or administer via same line.
* **Phosphate-containing solutions:** Physically incompatible (forms calcium phosphate precipitate).
## Monitoring
* **Serum Electrolytes:** Total and ionized calcium, magnesium, potassium.
* **Cardiac:** Continuous ECG monitoring during IV bolus/rapid infusion for arrhythmias or bradycardia.
* **Site:** Monitor frequently for extravasation.
## Clinical Pearls
* **Elemental Calcium:** 1 g of calcium gluconate = 90 mg (approx 4.5 mEq) of elemental calcium.
* **Extravasation:** Stop infusion immediately if extravasation occurs. Consult hospital protocols regarding the use of sodium thiosulfate as an antidote.
* **Concentration:** Always verify if using 10% solution; 10 mL of 10% solution provides 1 g of calcium gluconate.
* **Central vs. Peripheral:** Peripheral administration is acceptable if the vein is large and blood return is confirmed, but central access is preferred for repeated dosing.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify dosing, contraindications, and compatibility with your institution's specific clinical guidelines and the most current manufacturer prescribing information before administration.
