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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt that provides calcium ions. It is available in oral and intravenous formulations.
## Primary Indications
* **Hypocalcemia:** Treatment of calcium deficiency.
* **Cardiac Arrest:** Intravenous calcium may be considered in hyperkalemia or calcium channel blocker overdose.
* **Magnesium Sulfate Overdose:** Intravenous calcium is the antidote.
## Adult Dosing
Dosing is highly dependent on the clinical situation and severity of hypocalcemia. Consult institutional protocols.
* **Hypocalcemia (Oral):** Typically 1 to 2 grams of elemental calcium (equivalent to 980 mg to 1960 mg calcium gluconate) administered 1 to 4 times daily.
* **Hypocalcemia (IV):** 10 mL of 10% calcium gluconate (90 mg elemental calcium) infused over 5-10 minutes. May be repeated every 6 hours as needed. For severe or symptomatic hypocalcemia, a continuous infusion may be required, often guided by serum calcium levels and institutional guidelines.
* **Cardiac Arrest associated with Hyperkalemia or Hypomagnesemia:** 10 mL of 10% calcium gluconate (90 mg elemental calcium) IV push.
* **Magnesium Sulfate Overdose:** 10 mL of 10% calcium gluconate (90 mg elemental calcium) IV push.
## Pediatric Dosing
Dosing is highly dependent on the clinical situation and severity of hypocalcemia. Consult institutional protocols.
* **Hypocalcemia (Oral):** 45-65 mg of elemental calcium per kg per day, divided into 4-6 doses. (e.g., 1.1-1.6 g calcium gluconate per kg per day).
* **Hypocalcemia (IV):** 0.2 mL/kg of 10% calcium gluconate (approx. 20-24 mg elemental calcium/kg) infused slowly over 10-20 minutes. May be repeated every 6 hours.
## Dose Adjustments
No specific dose adjustments for renal or hepatic impairment are typically required for acute IV administration, but caution is advised in severe renal dysfunction. Oral absorption is reduced in renal impairment.
## Contraindications
* **Hypercalcemia:** High serum calcium levels.
* **Ventricular Fibrillation:** In the absence of specific indications like hyperkalemia or calcium channel blocker overdose.
* **Renal Calculi:** History of kidney stones (relative contraindication for chronic oral use).
* **Certain Cardiac Conditions:** Caution in patients with digitalis toxicity or specific arrhythmias.
## Adverse Effects
* **Common (IV):** Local irritation, phlebitis, extravasation leading to tissue necrosis.
* **Serious (IV):** Hypotension, bradycardia, cardiac arrhythmias, hypercalcemia, calcification of soft tissues.
* **Common (Oral):** Constipation, nausea, abdominal discomfort.
* **Serious (Oral):** Hypercalcemia.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Oral calcium can decrease absorption. Separate administration by at least 2 hours.
* **Bisphosphonates:** Oral calcium can decrease absorption. Separate administration by at least 2 hours.
* **Digoxin:** IV calcium can increase the risk of digoxin toxicity, particularly in patients with hypercalcemia.
* **Thiazide Diuretics:** Can increase serum calcium levels, potentially leading to hypercalcemia.
## Monitoring
* **Serum Calcium:** Frequently monitor serum calcium levels, especially with IV administration or for patients with risk factors for hypercalcemia.
* **Electrocardiogram (ECG):** Monitor for changes suggestive of hypercalcemia or hypocalcemia, particularly during IV administration or in critical care settings.
* **Renal Function:** Monitor renal function, as calcium can precipitate in renal tubules.
* **Signs of Extravasation:** With IV administration.
## Clinical Pearls
* IV calcium gluconate is less irritating than calcium chloride and can be administered peripherally, though central line administration is preferred for continuous infusions or large doses.
* Rapid IV infusion of calcium can cause hypotension and cardiac arrhythmias. Infuse slowly and monitor vital signs.
* Extravasation of IV calcium gluconate can cause severe tissue damage; ensure adequate venous access and stop infusion immediately if extravasation is suspected.
* Oral calcium absorption is significantly reduced when taken with food.
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*Please verify this information with the most current prescribing information and institutional protocols.*
