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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to restore serum calcium levels and stabilize cardiac membranes. It contains approximately 90 mg of elemental calcium per 1 gram of calcium gluconate. It is preferred over calcium chloride for peripheral administration due to a lower risk of tissue necrosis if extravasation occurs; however, central access is still preferred for high-concentration infusions.
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemia-induced cardiac membrane stabilization (does not lower potassium).
* Magnesium toxicity (antidote).
* Calcium channel blocker overdose.
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infused over 30–60 minutes. May repeat every 4–6 hours based on serum ionized calcium levels.
* **Cardiac Membrane Stabilization (Hyperkalemia/CCB Toxicity/Magnesium Toxicity):** 1–2 g IV push or rapid infusion over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist.
* *Note: Dosing is highly protocol-dependent; verify institutional guidelines for specific indications.*
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg (0.5–1 mL/kg of 10% solution) IV slow infusion over 30–60 minutes.
* **Cardiac Membrane Stabilization:** 50–100 mg/kg (0.5–1 mL/kg of 10% solution) IV pushed over 5–10 minutes. Maximum dose: 2 g per dose.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium levels closely as the risk of hypercalcemia is increased. No standardized dose reduction exists, but dose titrated to effect/serum levels is mandatory.
* **Hepatic Impairment:** No specific adjustment needed.
## Contraindications
* Ventricular fibrillation.
* Hypercalcemia.
* Digitalis toxicity (increased risk of arrhythmias).
* Severe renal impairment (relative contraindication requiring strict monitoring).
## Adverse Effects
* **Common:** Hypotension, bradycardia (if infused too rapidly), vasodilation, peripheral tingling, chalky taste.
* **Serious:** Cardiac arrhythmias, tissue necrosis/sloughing (if extravasated), tissue calcification.
## Key Drug Interactions
* **Digoxin:** Increases risk of severe digitalis toxicity and arrhythmias.
* **Ceftriaxone:** Physical incompatibility (forms insoluble precipitates). Do not administer via the same Y-site or in the same line without thorough flushing; avoid in neonates entirely.
* **Tetracyclines/Fluoroquinolones/Bisphosphonates:** Calcium may chelate these drugs, significantly reducing their bioavailability if given concurrently.
## Monitoring
* **ECG:** Mandatory during rapid administration to monitor for bradycardia or arrhythmias.
* **Serum Calcium:** Monitor ionized calcium (gold standard) or total serum calcium post-infusion.
* **Injection Site:** Monitor closely for signs of extravasation (pain, redness, swelling).
## Clinical Pearls
* **Never administer IM or SQ:** High risk of tissue necrosis and abscess formation.
* **Extravasation Management:** If extravasation occurs, stop infusion immediately, disconnect, and consider local infiltration with sodium thiosulfate if indicated by institutional policy.
* **Compatibility:** Calcium is incompatible with carbonates, phosphates, and sulfates; ensure IV lines are flushed with normal saline before and after administration.
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**Disclaimer:** This information is for educational purposes only. Always verify doses, contraindications, and drug-drug interactions through your institution’s clinical protocols and current prescribing information (e.g., package inserts or drug databases like Lexicomp or Micromedex) before administration.
