Calcium%2525252525252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt of gluconic acid and a source of calcium. It is available in oral and intravenous formulations. ## Primary Indications * Hypocalcemia * Adjunct in management of cardiac arrest associated with hyperkalemia * Magnesium sulfate overdose * Hydrofluoric acid burns (topical) ## Adult Dosing * **Hypocalcemia:** * **IV:** 10 mL of a 10% solution (1000 mg elemental calcium) administered slowly over 10-20 minutes. May be repeated every 6 hours as needed, or via continuous infusion. Rate of infusion should not exceed 200 mg elemental calcium/minute. * **Oral:** Dosing varies significantly based on formulation and patient need. Generally, 1-2 grams of elemental calcium per day in divided doses. For example, 2 grams of calcium gluconate (approximately 180 mg elemental calcium) given 2-3 times daily. * **Hyperkalemia (adjunct):** 10 mL of a 10% solution (1000 mg elemental calcium) IV over 5-10 minutes. * **Magnesium Sulfate Overdose:** 10 mL of a 10% solution (1000 mg elemental calcium) IV over 3-5 minutes. * **Hydrofluoric Acid Burns (Topical):** Typically prepared as a 2.5% gel or solution. Apply liberally and frequently to the affected area. ## Pediatric Dosing * **Hypocalcemia:** * **IV:** 1-2 mL/kg of a 10% solution (100-200 mg elemental calcium/kg) administered slowly over 10-20 minutes. Maximum infusion rate is 100 mg elemental calcium/minute. May be repeated every 6 hours. Higher doses may be required in certain situations, guided by serum calcium levels and clinical response. * **Oral:** Dosing varies significantly based on age and formulation. Common general target is 45-50 mg elemental calcium/kg/day in divided doses. * **Hyperkalemia (adjunct):** 1-2 mL/kg of a 10% solution (100-200 mg elemental calcium/kg) IV over 5-10 minutes. * **Magnesium Sulfate Overdose:** 1-2 mL/kg of a 10% solution (100-200 mg elemental calcium/kg) IV over 3-5 minutes. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment for acute IV administration, but caution is advised in severe renal insufficiency due to potential for hypercalcemia. Oral calcium absorption may be reduced in renal impairment. ## Contraindications * Hypercalcemia * Ventricular fibrillation * Renal calculi (relative contraindication for oral calcium) * History of hypersensitivity to calcium products ## Adverse Effects * **IV:** Hypotension, bradycardia, arrhythmias, phlebitis, tissue necrosis (if extravasation), hypercalcemia, nausea, vomiting, constipation, metallic taste. * **Oral:** Constipation, abdominal discomfort, hypercalcemia. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium gluconate can chelate these antibiotics, decreasing their absorption. Separate administration by at least 2-4 hours. * **Bisphosphonates:** Oral calcium can decrease the absorption of bisphosphonates. Separate administration by at least 30 minutes (or longer, depending on the specific bisphosphonate). * **Digoxin:** IV calcium can increase the risk of digoxin toxicity, particularly in patients with hypercalcemia or hypokalemia. * **Thiazide Diuretics:** Can increase serum calcium levels. ## Monitoring * Serum calcium levels (ionized calcium is preferred). * Electrocardiogram (ECG) for ECG changes suggestive of hypocalcemia or hypercalcemia. * Renal function. * Signs and symptoms of hypocalcemia or hypercalcemia. ## Clinical Pearls * Intravenous calcium gluconate should be administered slowly to avoid hypotension and cardiac arrhythmias. Rapid IV administration can lead to hypercalcemia. * Avoid administration via the same IV line as bicarbonate or phosphate solutions due to precipitation risk. * In cases of severe hypocalcemia, intravenous calcium chloride may be preferred due to higher elemental calcium content per mL, but it is more irritating and can cause more tissue damage if extravasated. * Oral calcium absorption is best when taken with meals. * Monitor for signs of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, confusion). *** *Disclaimer: This information is intended for healthcare professionals. Always verify current prescribing information and institutional protocols before administering any medication.*