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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt used to treat and prevent calcium deficiencies. It is available in oral and intravenous (IV) formulations.
## Primary Indications
* **Hypocalcemia:** Treatment of symptomatic hypocalcemia (e.g., tetany, paresthesias).
* **Calcium Deficiency:** Prevention and treatment of calcium deficiency when dietary intake is inadequate.
* **Other:** Adjunctive therapy in certain conditions like cardiac arrest, hyperkalemia (IV), or as an antidote for magnesium sulfate overdose or hydrofluoric acid exposure.
## Adult Dosing
Dosing is highly variable based on indication and severity. Actual doses depend on the specific calcium salt and elemental calcium content.
* **Hypocalcemia (IV):** 10 mL of 10% calcium gluconate solution (90 mg elemental calcium) administered slowly, typically over 10-20 minutes. May be repeated every 1-6 hours as needed. Continuous infusion may be used in severe cases. **Maximum rate of infusion is generally 100 mg elemental calcium/minute.**
* **Hypocalcemia (Oral):** Varies widely based on product and indication. Elemental calcium content must be calculated.
## Pediatric Dosing
Dosing is based on weight and clinical assessment. Actual doses depend on the specific calcium salt and elemental calcium content.
* **Hypocalcemia (IV):**
* **Neonates:** 100-200 mg/kg/day divided into 4-6 doses.
* **Infants and Children:** 50-100 mg/kg (up to 1-2 g) IV over 10-20 minutes. May be repeated every 4-6 hours. **Maximum infusion rate is 100 mg/kg/minute (or 1 mL/kg/min of a 10% solution).**
* **Hypocalcemia (Oral):** Varies widely based on product and indication. Elemental calcium content must be calculated.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised in patients with impaired renal function due to the risk of hypercalcemia.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation during resuscitation
* Severe renal impairment
* History of calcium-containing kidney stones
## Adverse Effects
* **IV:** Hypotension, vasodilation, bradycardia, arrhythmias, tissue calcification/necrosis (if extravasation occurs), warmth, phlebitis.
* **Oral:** Constipation, abdominal discomfort, nausea, hypercalcemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium can chelate with these antibiotics, decreasing their absorption. Separate administration by at least 2-4 hours.
* **Bisphosphonates and Thyroid Hormones:** Calcium can decrease absorption. Separate administration.
* **Thiazide Diuretics:** May increase serum calcium levels, potentiating the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Antacids:** Increased risk of hypercalcemia.
## Monitoring
* Serum calcium levels (frequently during IV administration, especially in patients with renal impairment or receiving cardiac resuscitation).
* Renal function.
* Signs and symptoms of hypocalcemia or hypercalcemia.
* ECG, particularly during IV administration.
## Clinical Pearls
* IV calcium gluconate is less irritating than calcium chloride and is preferred for peripheral IV administration.
* Always administer IV calcium slowly and monitor for adverse effects. Do not exceed recommended infusion rates.
* Avoid IM or SC administration of calcium solutions due to tissue irritation and necrosis.
* In cases of severe hypocalcemia or when rapid correction is needed, IV calcium chloride may be preferred due to higher elemental calcium content, but it is more irritating.
* Ensure adequate hydration, especially when administering oral calcium supplements.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and relevant clinical guidelines before making any treatment decisions.
