Calcium%252525252525252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt used to treat or prevent calcium deficiencies. It is available in oral and intravenous (IV) formulations. ## Primary Indications * Hypocalcemia * Cardiac emergencies associated with hyperkalemia (IV) * Management of ingestion of certain toxic substances (e.g., hydrofluoric acid, magnesium sulfate) (IV) ## Adult Dosing * **Hypocalcemia (IV):** 1 to 2 grams of elemental calcium (equivalent to 9.8 to 19.6 mL of a 10% solution) administered slowly over 10-20 minutes. May be repeated every 6 hours as needed. For severe symptoms or hypocalcemic tetany, continuous infusion may be necessary, typically 1 gram/hour. Specific dosing and rate of infusion depend on local protocol and patient response. * **Cardiac Arrest with Hyperkalemia (IV):** 1 to 1.5 grams (10 to 15 mL of 10% solution) IV. This is a temporizing measure to stabilize the myocardium and does not remove potassium. * **Hydrofluoric Acid Exposure:** Consult specialized protocols. Topical, subcutaneous, or intra-arterial administration may be used. ## Pediatric Dosing * **Hypocalcemia (IV):** 100 to 200 mg/kg (equivalent to 1 to 2 mL/kg of 10% solution) IV over 10-20 minutes. Maximum dose of 1 gram. May be repeated every 6 hours as needed. Specific dosing depends on local protocol and patient response. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, though caution is advised in severe renal dysfunction due to potential calcium accumulation. ## Contraindications * Hypercalcemia * History of kidney stones (caution) * Certain cardiac conditions (e.g., ventricular fibrillation) ## Adverse Effects * **IV:** Hypotension, bradycardia, arrhythmias, phlebitis, tissue necrosis (if extravasation occurs), hypercalcemia. Rapid infusion can cause flushing, nausea, vomiting, and a metallic taste. * **Oral:** Constipation, abdominal discomfort. ## Key Drug Interactions * **Cardiac Glycosides (e.g., Digoxin):** Increased risk of arrhythmias if hypercalcemia develops. * **Tetracyclines and Fluoroquinolones:** Oral calcium can decrease absorption. Separate administration by at least 2 hours. * **Bisphosphonates and Sodium Fluoride:** Oral calcium can decrease absorption. Separate administration by at least 2 hours. * **Thiazide Diuretics:** Can increase serum calcium levels. ## Monitoring * Serum calcium levels (frequently, especially with IV administration) * Renal function * Cardiac rhythm (during rapid IV administration) * Signs and symptoms of hypocalcemia or hypercalcemia ## Clinical Pearls * Always administer IV calcium slowly to avoid hypotension and arrhythmias. * Never administer IV calcium through the same IV line as bicarbonate or phosphate solutions due to precipitation risk. * For IV administration, use a central line if possible, especially for continuous infusions. * Ensure adequate hydration when administering oral calcium. * Be aware of the elemental calcium content: Calcium gluconate is approximately 9% elemental calcium by weight (1 gram of calcium gluconate contains about 90 mg elemental calcium). *** *This information is intended for healthcare professionals. Please consult the most current prescribing information and relevant clinical guidelines for complete details and to verify dosages and safety information before use.*