Calcium%25252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt used to treat or prevent calcium deficiencies. It is available in oral and intravenous (IV) formulations. ## Primary Indications * Hypocalcemia (treatment and prevention) * Magnesium sulfate overdose (IV) * Hydrofluoric acid exposure (topical/irrigation) ## Adult Dosing * **Hypocalcemia:** * Oral: 1 to 2 grams of elemental calcium (equivalent to 980 mg to 1.96 grams of calcium gluconate) three to four times daily. Specific oral formulations vary, so confirm elemental calcium content. * IV: 1 to 2 grams (10 mL to 20 mL of 10% solution) administered slowly over 5 to 10 minutes. May be repeated every 6 hours as needed. For severe hypocalcemia or symptomatic treatment, doses up to 4 grams may be administered. Rate of infusion should not exceed 200 mg elemental calcium per minute. * **Magnesium Sulfate Overdose (IV):** 1 gram (10 mL of 10% solution) administered IV over 1 to 3 minutes. May be repeated every minute up to 3 times as needed. * **Hydrofluoric Acid Exposure:** Topical gel or irrigation with a solution containing calcium gluconate, as per institutional protocol. ## Pediatric Dosing * **Hypocalcemia:** * Oral: 45-65 mg/kg/day of elemental calcium (equivalent to approximately 450-650 mg/kg/day of calcium gluconate) divided into 3-4 doses. Specific oral formulations vary, so confirm elemental calcium content. * IV: 100-200 mg/kg/day of elemental calcium (equivalent to approximately 1 mL to 2 mL/kg/day of 10% calcium gluconate) divided into 4-6 doses. Administer slowly, not exceeding 5 mL/min. Neonates require slower infusion rates (e.g., 1 mL/min) and should be monitored for bradycardia. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised in patients with impaired kidney function due to potential for hypercalcemia. ## Contraindications * Hypercalcemia * History of kidney stones (nephrolithiasis) * Ventricular fibrillation (IV) * Conditions that may cause ectopic calcification ## Adverse Effects * **Common (Oral):** Constipation, nausea, vomiting. * **Common (IV):** Hypotension, bradycardia, cardiac arrhythmias, phlebitis, sensation of warmth, chalky taste. Extravasation can cause tissue necrosis. * **Rare:** Hypercalcemia, hypercalciuria. ## Key Drug Interactions * **Tetracyclines and Quinolones:** Calcium can chelate with these antibiotics, reducing absorption. Separate administration by at least 2 hours before or 4-6 hours after. * **Bisphosphonates, Thyroid Hormones, Iron Supplements:** Calcium can decrease the absorption of these agents. Separate administration. * **Digoxin:** IV calcium can increase the risk of digoxin toxicity, especially in patients with hypercalcemia. * **Thiazide Diuretics:** Can increase serum calcium levels. * **Vitamin D:** Enhances calcium absorption. ## Monitoring * Serum calcium levels (especially with IV administration or in patients with risk factors for hypercalcemia) * Renal function * Cardiac rhythm (especially with rapid IV administration) * Signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, confusion, polyuria) ## Clinical Pearls * IV calcium gluconate should be administered slowly to prevent hypotension and cardiac arrhythmias. * Never administer IV calcium gluconate through the same IV line as bicarbonate or phosphate solutions due to precipitation risk. * Oral calcium carbonate is often preferred for chronic supplementation due to higher elemental calcium content per gram, but calcium gluconate may be better tolerated in some individuals. * For IV administration in neonates, administer through a central line if possible, and monitor for bradycardia. * Ensure adequate hydration when administering calcium, especially orally. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the current prescribing information and relevant guidelines for complete details and to ensure patient safety. Dosing may vary based on patient-specific factors and local protocols.