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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt used to treat or prevent low blood calcium levels (hypocalcemia). It is available in oral and intravenous (IV) formulations.
## Primary Indications
* Hypocalcemia
* Magnesium sulfate overdose (IV)
* Hydrofluoric acid burns (topical/IV)
## Adult Dosing
* **Hypocalcemia (IV):** 10-20 mL of 10% calcium gluconate solution (typically 90-180 mg elemental calcium) infused slowly over 10-20 minutes. Higher doses may be needed and should be guided by serum calcium levels and clinical response. Maximum infusion rate is typically 100 mg elemental calcium per minute.
* **Hypocalcemia (Oral):** Varies widely based on formulation and severity of deficiency. Typically 1-4 grams of elemental calcium daily, divided into multiple doses.
## Pediatric Dosing
* **Hypocalcemia (IV):** 0.5-1 mL/kg of 10% calcium gluconate solution (typically 45-90 mg elemental calcium/kg) infused slowly over 10-20 minutes. Maximum infusion rate is typically 100 mg elemental calcium per minute. Adjustments based on serum calcium levels and clinical response.
* **Hypocalcemia (Oral):** Varies widely. Typically 45-65 mg elemental calcium/kg/day, divided into 4 doses.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, but caution is advised in these populations due to potential calcium accumulation.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Renal calculi (history of)
## Adverse Effects
* **IV:** Hypotension, bradycardia, arrhythmias, phlebitis, local tissue necrosis (if extravasated), hypercalcemia.
* **Oral:** Constipation, nausea, vomiting, abdominal pain, hypercalcemia.
## Key Drug Interactions
* **Digoxin:** Increased risk of cardiac arrhythmias.
* **Tetracyclines/Fluoroquinolones:** Decreased absorption of antibiotics. Administer calcium salts at least 2 hours before or 4-6 hours after these antibiotics.
* **Thiazide Diuretics:** Increased risk of hypercalcemia.
* **Calcium Channel Blockers:** May decrease the effectiveness of calcium channel blockers.
## Monitoring
* Serum calcium levels (frequent monitoring during IV infusion and periodically during oral therapy)
* ECG (especially during IV administration)
* Renal function
* Signs and symptoms of hypercalcemia
## Clinical Pearls
* IV calcium gluconate should be administered slowly to avoid hypotension and cardiac arrhythmias.
* Never infuse IV calcium gluconate through the same IV line as sodium bicarbonate or other alkaline solutions, as this can cause precipitation.
* For IV administration, central venous access is preferred to minimize risk of phlebitis and extravasation.
* Oral calcium carbonate is generally preferred for chronic calcium supplementation due to higher elemental calcium content per gram and lower cost, but calcium gluconate may be used if carbonate is not tolerated.
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**Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and clinical guidelines before making any treatment decisions. Dosing may vary based on patient-specific factors and local institutional protocols.
