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## Calcium Gluconate
### Overview
Calcium gluconate is an inorganic salt used to treat and prevent low blood calcium levels. It is available in oral and intravenous (IV) formulations.
### Primary Indications
* Hypocalcemia
* Magnesium sulfate overdose
* Hydrofluoric acid burns (topical)
* Cardiac arrest (as adjunctive therapy in hyperkalemia or calcium channel blocker overdose)
### Adult Dosing
* **Hypocalcemia (IV):** 10 mL of 10% calcium gluconate solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly over 5-10 minutes. May be repeated every 1-6 hours as needed, guided by serum calcium levels.
* **Hypocalcemia (Oral):** Dosing varies significantly based on formulation and individual needs; consult product labeling or institutional guidelines. Typical doses range from 1-2 grams of elemental calcium daily, divided into multiple doses.
* **Cardiac Arrest (IV):** 10 mL of 10% calcium gluconate solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly over 5-10 minutes. Repeat doses guided by clinical response and serum calcium levels.
* **Magnesium Sulfate Overdose (IV):** 10 mL of 10% calcium gluconate solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly. Repeat doses may be necessary.
* **Hydrofluoric Acid Burns (Topical):** Gel or solution applied liberally to the affected area after thorough irrigation.
### Pediatric Dosing
* **Hypocalcemia (IV):** 0.5-1 mL/kg of 10% calcium gluconate solution (equivalent to 45-90 mg elemental calcium or 2.25-4.5 mEq/kg) administered slowly over 5-10 minutes. Maximum single dose is typically 10 mL. May be repeated every 1-6 hours as needed, guided by serum calcium levels.
* **Cardiac Arrest (IV):** 0.1-0.2 mL/kg of 10% calcium gluconate solution (equivalent to 10-20 mg elemental calcium or 0.5-1 mEq/kg) administered slowly. Repeat doses guided by clinical response and serum calcium levels.
### Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, however, caution is advised in patients with impaired renal function due to potential for hypercalcemia.
### Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Concurrent administration of ceftriaxone in neonates (risk of precipitate formation)
### Adverse Effects
* **IV:** Hypotension, bradycardia, arrhythmias, local irritation, extravasation leading to tissue necrosis, constipation, nausea, vomiting.
* **Oral:** Constipation, gastrointestinal upset.
### Key Drug Interactions
* **Tetracyclines and Quinolones:** Oral calcium gluconate can decrease the absorption of these antibiotics; administer at least 2 hours before or 4-6 hours after.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** Can increase serum calcium levels, increasing the risk of hypercalcemia.
* **Bisphosphonates and Sodium Fluoride:** Concurrent use may decrease absorption of these agents.
### Monitoring
* Serum calcium levels (frequently during IV administration and as clinically indicated).
* Electrocardiogram (ECG) for signs of hypercalcemia or hypocalcemia.
* Renal function.
* Signs and symptoms of extravasation with IV administration.
### Clinical Pearls
* IV calcium gluconate should be administered slowly to avoid hypotension and arrhythmias. Rapid infusion can cause vasodilation and a sudden drop in blood pressure.
* Avoid IM administration of calcium gluconate due to risk of tissue necrosis.
* Ensure adequate venous access for IV administration and have emergency equipment readily available.
* Oral calcium gluconate absorption is enhanced when taken with food.
* Monitor for signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, confusion) if excessive doses are administered.
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**Disclaimer:** This information is intended for healthcare professionals and does not replace the need to consult the official prescribing information or current clinical practice guidelines. Always verify current dosing, indications, contraindications, and safety information before prescribing or administering any medication.
