Calcium%25252525252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt providing calcium, an essential electrolyte for bone health, neuromuscular function, and cardiac function. ## Primary Indications * Hypocalcemia (symptomatic and asymptomatic) * Adjunctive treatment in hyperkalemia (to stabilize cardiac membranes) * Adjunctive treatment in magnesium sulfate overdose ## Adult Dosing * **Hypocalcemia:** * Intravenous (IV): 10 mL of a 10% solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly over 5-10 minutes. May be repeated every 6-12 hours as needed, guided by serum calcium levels and clinical response. The maximum total daily dose is not well-defined and depends on individual patient needs and monitoring. * Oral: Dosing is highly variable and depends on the degree of deficiency and calcium content of the formulation. Typical daily elemental calcium intake ranges from 1000-2000 mg. * **Adjunctive therapy in hyperkalemia:** * IV: 10 mL of a 10% solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly over 5-10 minutes. This dose does not correct the hyperkalemia but serves to protect the heart from the effects of elevated potassium. * **Adjunctive therapy in magnesium sulfate overdose:** * IV: 10 mL of a 10% solution (equivalent to 90 mg elemental calcium or 4.5 mEq) administered slowly. ## Pediatric Dosing * **Hypocalcemia:** * IV: 0.5-1 mL/kg of a 10% solution (equivalent to 45-90 mg elemental calcium/kg or 2.25-4.5 mEq/kg) administered slowly over 5-10 minutes. May be repeated every 6-12 hours as needed. Maximum single dose not well-defined. Neonatal doses may be higher. * Oral: Dosing is highly variable and depends on the degree of deficiency and calcium content of the formulation. * **Adjunctive therapy in hyperkalemia:** * IV: 0.5-1 mL/kg of a 10% solution (equivalent to 45-90 mg elemental calcium/kg or 2.25-4.5 mEq/kg) administered slowly over 5-10 minutes. * **Adjunctive therapy in magnesium sulfate overdose:** * IV: 0.5-1 mL/kg of a 10% solution (equivalent to 45-90 mg elemental calcium/kg or 2.25-4.5 mEq/kg) administered slowly. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, as calcium is handled differently. However, caution is advised in patients with renal insufficiency, especially with oral formulations, due to potential for hypercalcemia. ## Contraindications * Hypercalcemia * Ventricular fibrillation * Hypersensitivity to calcium gluconate ## Adverse Effects * **IV Administration:** Hypotension, bradycardia, arrhythmias, peripheral vasodilation, phlebitis, extravasation leading to tissue necrosis, constipation, nausea, vomiting, dry mouth. Rapid IV injection can cause cardiac arrest. * **Oral Administration:** Constipation, bloating, gas, hypercalcemia. ## Key Drug Interactions * **Bisphosphonates, Quinolones, Tetracyclines:** Oral calcium gluconate can decrease the absorption of these drugs. Separate administration by at least 2-4 hours. * **Digoxin:** Hypercalcemia increases the risk of digoxin toxicity. * **Thiazide Diuretics:** May increase serum calcium levels, potentially leading to hypercalcemia. * **Vitamin D:** Enhances calcium absorption. Concurrent use may increase the risk of hypercalcemia. ## Monitoring * Serial serum calcium levels (total and ionized) * Electrocardiogram (ECG) if administering IV rapidly or in patients with cardiac conditions * Renal function (creatinine, BUN) * Signs and symptoms of hypercalcemia (confusion, lethargy, nausea, vomiting, constipation, polyuria) ## Clinical Pearls * Always confirm the concentration of calcium gluconate (e.g., 10% solution) and calculate elemental calcium or mEq dose for accuracy. * IV calcium gluconate should be administered slowly to avoid adverse cardiovascular effects and extravasation. * If extravasation occurs, inject hyaluronidase locally to disperse the calcium. * Oral calcium supplements should be taken with food to enhance absorption. * In hyperkalemia, IV calcium gluconate does not lower potassium but protects the myocardium. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the official prescribing information and institutional protocols for the most current and complete drug details before making any clinical decisions.