Calcium%25252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt that provides calcium, an essential mineral for bone health, nerve transmission, muscle contraction, and cardiac function. It is available in oral and intravenous formulations. ## Primary Indications * Treatment and prevention of calcium deficiency (hypocalcemia). * Adjunctive treatment of conditions related to calcium deficiency, such as osteoporosis, rickets, and osteomalacia. * Antidote for magnesium sulfate overdose. * Antidote for hydrofluoric acid burns (topical). * Treatment of hyperkalemia (to stabilize cardiac membrane). ## Adult Dosing * **Hypocalcemia:** * **Intravenous:** 10 mL of a 10% solution (100 mg elemental calcium) administered over 5-10 minutes. May be repeated every 1-6 hours as needed. Higher doses may be required in severe cases. * **Oral:** 1-2 grams elemental calcium (e.g., 980-1960 mg calcium gluconate) administered 1-4 times daily. Specific oral doses vary widely depending on the formulation and elemental calcium content. * **Hyperkalemia:** * **Intravenous:** 10 mL of a 10% solution (100 mg elemental calcium) administered over 2-5 minutes. This does not lower potassium levels but stabilizes the cardiac membrane. * **Magnesium Sulfate Overdose:** * **Intravenous:** 10 mL of a 10% solution (100 mg elemental calcium) administered over 1-3 minutes. May be repeated if necessary. ## Pediatric Dosing * **Hypocalcemia:** * **Intravenous:** 1-2 mL/kg of a 10% solution (100-200 mg elemental calcium/kg) administered over 10-20 minutes. May be followed by an infusion of 0.5-1 mL/kg/hour (50-100 mg elemental calcium/kg/hour). Dosing should be guided by serum calcium levels and local protocol. * **Oral:** Varies widely based on age, indication, and elemental calcium content. Consult specific pediatric guidelines. * **Newborns with suspected hypocalcemia:** 1 mL/kg of a 10% solution (100 mg elemental calcium/kg) over 10-20 minutes. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised in severe renal disease due to the potential for hypercalcemia. Monitor calcium levels closely. ## Contraindications * Hypercalcemia. * History of calcium nephrolithiasis (kidney stones). * Severe renal impairment with hypercalcemia. * Ventricular fibrillation. ## Adverse Effects * **Intravenous:** Hypotension, bradycardia, arrhythmias, sensation of warmth, phlebitis, extravasation leading to tissue necrosis. * **Oral:** Constipation, nausea, vomiting, abdominal discomfort. * **General:** Hypercalcemia (symptoms include confusion, fatigue, nausea, vomiting, constipation, polyuria, cardiac arrhythmias). ## Key Drug Interactions * **Cardiac Glycosides (e.g., Digoxin):** Increased risk of arrhythmias due to enhanced cardiac effects of calcium. * **Tetracyclines and Quinolones:** Calcium can chelate these antibiotics, reducing their absorption. Separate administration by at least 2 hours before or 4-6 hours after calcium. * **Bisphosphonates and Thyroid Hormones:** Calcium can decrease the absorption of these agents. Separate administration. * **Thiazide Diuretics:** May increase the risk of hypercalcemia. * **Vitamin D Analogs:** Enhance calcium absorption, increasing the risk of hypercalcemia. ## Monitoring * Serum calcium levels (total and ionized calcium). * Electrolytes. * Renal function. * Cardiac rhythm, especially with intravenous administration or in patients with cardiac conditions. ## Clinical Pearls * Intravenous calcium gluconate is less irritating than calcium chloride but provides less elemental calcium per volume. * Always administer intravenous calcium slowly to avoid hypotension and arrhythmias. * Ensure adequate venous access and use an infusion pump for continuous infusions. * Extravasation of calcium can cause severe tissue damage; monitor the IV site closely. * Oral calcium absorption is enhanced by vitamin D; ensure adequate vitamin D status. * Monitor for signs and symptoms of hypercalcemia. *** *This information is intended for healthcare professionals. Always consult the most current prescribing information and local protocols for complete details before making any clinical decisions.*