Calcium%2525252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt used to treat or prevent calcium deficiency. It is available in oral and intravenous formulations. ## Primary Indications * Hypocalcemia (treatment and prevention) * Magnesium sulfate overdose (antidote) * As an adjunctive treatment for hyperkalemia (pending definitive treatment) * Hydrofluoric acid burns (topical) ## Adult Dosing * **Hypocalcemia (IV):** 4.5-5.6 mEq/kg/day divided into 4 doses (e.g., 1 gram calcium gluconate = 90 mg elemental calcium). Doses may range from 1 to 2 grams IV every 6-12 hours, based on patient response and serum calcium levels. Specific dosing often depends on local protocol. * **Hypocalcemia (Oral):** 1 to 2 grams elemental calcium (equivalent to 11 to 22 grams calcium gluconate) divided daily. * **Magnesium Sulfate Overdose (IV):** 1.25 to 5 grams calcium gluconate (5 to 20 mEq calcium) slow IV push, titrated to reversal of signs/symptoms of magnesium toxicity. * **Hyperkalemia (IV):** 1 to 3 grams calcium gluconate (3 to 9 mEq calcium) IV, administered as a slow push, over 2-5 minutes. *Note: This does not lower potassium levels, but stabilizes cardiac membranes.* * **Hydrofluoric Acid Burns (Topical):** 2.5% topical gel or solution applied to affected area. ## Pediatric Dosing * **Hypocalcemia (IV):** 1 to 2 mEq/kg/dose (equivalent to 110 to 220 mg elemental calcium per kg or 1.1 to 2.2 mL/kg of a 10% solution) administered slowly, not exceeding 1 mL/min. Doses may be repeated every 6-12 hours as needed. * **Hypocalcemia (Oral):** 45-65 mg elemental calcium/kg/day divided into 3-4 doses. ## Dose Adjustments No dose adjustment is typically needed for renal or hepatic impairment, but caution is advised in severe renal impairment due to potential calcium accumulation. ## Contraindications * Hypercalcemia * Ventricular fibrillation * History of calcium nephrolithiasis or calcinosis * Renal osteodystrophy with hyperphosphatemia ## Adverse Effects * **IV:** Hypotension, bradycardia, arrhythmias, local irritation, extravasation (can cause tissue necrosis), hypercalcemia, calcification of tissues. * **Oral:** Constipation, nausea, vomiting, abdominal discomfort. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium gluconate can decrease absorption. Separate administration by at least 2 hours. * **Bisphosphonates:** Calcium gluconate can decrease absorption. Separate administration by at least 2 hours. * **Digoxin:** IV calcium may potentiate digoxin toxicity in patients with hypercalcemia. * **Thiazide Diuretics:** May increase the risk of hypercalcemia. * **Vitamin D:** Enhances calcium absorption. ## Monitoring * Serum calcium levels (frequently, especially with IV administration) * ECG (especially with IV administration for arrhythmias or hyperkalemia) * Renal function * Signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, confusion) ## Clinical Pearls * IV calcium gluconate should be administered slowly to avoid hypotension and cardiac arrhythmias. * Never administer IV calcium gluconate peripherally if the patient is also receiving sodium bicarbonate or if the solution contains precipitates, as this can cause phlebitis and tissue damage. Prefer central line administration. * Ensure adequate hydration when administering oral calcium. * Monitor for signs of hypercalcemia, especially with IV administration. --- *This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant literature for complete details and to verify information before use.*