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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt of calcium used to treat or prevent calcium deficiency. It is available in oral and intravenous formulations.
## Primary Indications
* Hypocalcemia (symptomatic and asymptomatic)
* Adjunctive treatment in cardiac arrest with hyperkalemia
* Treatment of magnesium sulfate overdose
* Topical treatment of hydrofluoric acid burns
## Adult Dosing
* **Hypocalcemia:**
* **Intravenous:** 10 mL of 10% calcium gluconate (90 mg elemental calcium) administered slowly over 10-20 minutes. May be repeated every 1-6 hours as needed. For severe symptomatic hypocalcemia or cardiac arrest, may administer more rapidly and repeat doses more frequently based on clinical response and calcium levels.
* **Oral:** 1 to 2 grams of elemental calcium (e.g., 10-20 mL of 10% solution, or tablets providing 500-650 mg elemental calcium) three to four times daily. Specific oral dose depends on the formulation's elemental calcium content.
* **Magnesium Sulfate Overdose:** 10 mL of 10% calcium gluconate (90 mg elemental calcium) intravenously every 1-5 minutes until reversal of magnesium toxicity symptoms.
* **Hydrofluoric Acid Burns:** Apply topical gel liberally to affected area and cover with a sterile dressing. Reapply every 15 minutes.
## Pediatric Dosing
* **Hypocalcemia:**
* **Intravenous:** 0.5 to 1 mL/kg of 10% calcium gluconate (45-90 mg elemental calcium) administered intravenously over 10-20 minutes. May be repeated every 6 hours as needed. Higher doses may be required in premature infants or those with severe hypocalcemia. Specific dosing may be guided by local protocols.
* **Oral:** Dosing varies widely based on age and indication. Consult specific pediatric guidelines.
## Dose Adjustments
No specific dose adjustments are routinely required for renal or hepatic impairment, but caution is advised in severe renal impairment due to potential calcium accumulation.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Renal calculi (history)
## Adverse Effects
* **Intravenous:** Hypotension, bradycardia, cardiac arrhythmias, venous irritation, phlebitis, extravasation leading to tissue necrosis, warmth, tingling.
* **Oral:** Constipation, nausea, abdominal pain, dry mouth.
## Key Drug Interactions
* **Tetracyclines and Quinolones:** Calcium gluconate can decrease absorption. Separate administration by at least 2 hours before or 4-6 hours after.
* **Bisphosphonates:** Calcium can decrease absorption. Separate administration by at least 2 hours.
* **Digoxin:** Increased risk of digoxin toxicity if hypercalcemia occurs.
* **Thiazide Diuretics:** Increased risk of hypercalcemia.
## Monitoring
* Serum calcium levels (frequently during IV administration, then as clinically indicated)
* ECG (especially during rapid IV administration or in patients with cardiac history)
* Renal function
* Signs and symptoms of hypocalcemia or hypercalcemia
## Clinical Pearls
* Administer IV calcium gluconate slowly to prevent hypotension and arrhythmias.
* Do NOT administer IV calcium gluconate through the same IV line as sodium bicarbonate or solutions containing bicarbonate, phosphate, or carbonate, as this can cause precipitation.
* Ensure adequate hydration when administering oral calcium.
* Monitor for signs of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, confusion).
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*Disclaimer: This information is intended for healthcare professionals. Always consult the current prescribing information and relevant clinical guidelines for definitive guidance.*
