Calcium%25252525252525252525252525252525252525252525252525252525252525252520gluconate

# 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 (treatment and prevention) * Magnesium sulfate overdose (IV) * Hydrofluoric acid skin burns (topical) ## Adult Dosing * **Hypocalcemia (IV):** Typically 1 to 2 grams (10-20 mL of 10% solution) administered slowly IV. Rate of administration should not exceed 1 mL/min (100 mg/min). May be repeated every 6-12 hours. *Specific dosing and infusion rates may depend on local protocol and severity of hypocalcemia.* * **Hypocalcemia (Oral):** Varies widely based on formulation and indication. Common elemental calcium doses range from 1 to 2 grams per day, divided into multiple doses. * **Magnesium Sulfate Overdose (IV):** 1 gram (10 mL of 10% solution) IV, repeated every 1-4 minutes as needed. * **Hydrofluoric Acid Burns (Topical):** 2.5% topical gel applied liberally and covered with occlusive dressing. May be repeated every 15 minutes. Intra-arterial or subcutaneous injection may be considered for severe burns, but this is often guided by specialized burn protocols. ## Pediatric Dosing * **Hypocalcemia (IV):** 0.5 to 1 mL/kg (50-100 mg elemental calcium/kg) of a 10% solution infused slowly over 10-20 minutes. Do not exceed 1 mL/min. May be repeated every 6-12 hours. *Specific dosing and infusion rates may depend on local protocol and severity of hypocalcemia.* Neonates may require smaller doses. * **Hypocalcemia (Oral):** Dosing is highly variable; consult pediatric guidelines. ## Dose Adjustments No specific dose adjustments are typically required for renal or hepatic impairment, as calcium is metabolized and excreted differently. However, caution is advised in patients with renal impairment due to potential for hypercalcemia. ## Contraindications * Hypercalcemia * Ventricular fibrillation (IV administration) * History of calcium-containing kidney stones (relative contraindication for oral supplementation) ## Adverse Effects * **IV:** Extravasation leading to tissue necrosis, hypotension, bradycardia, arrhythmias, hypercalcemia, warmth, flushing, phlebitis. * **Oral:** Constipation, nausea, vomiting, abdominal discomfort, hypercalcemia. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium can chelate with these antibiotics, decreasing their absorption. Separate administration by at least 2-4 hours. * **Bisphosphonates:** Calcium can reduce the absorption of bisphosphonates. Separate administration by at least 2 hours. * **Thyroid Hormones:** Calcium can decrease the absorption of levothyroxine. Separate administration by at least 4 hours. * **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity. * **Thiazide Diuretics:** Can increase serum calcium levels. ## Monitoring * Serum calcium levels (prior to and during therapy) * Renal function (BUN, creatinine) * Signs and symptoms of hypercalcemia (confusion, nausea, vomiting, constipation, bone pain, polyuria, polydipsia) * Cardiac rhythm (especially with rapid IV administration) * Signs of extravasation with IV administration ## Clinical Pearls * IV calcium gluconate should be administered slowly to prevent hypotension and arrhythmias. It should not be infused rapidly into a peripheral vein due to its potential to cause phlebitis and tissue necrosis. * Always confirm the concentration of the calcium gluconate solution being administered (e.g., 10% solution contains 0.92 mEq of elemental calcium per mL, or 9.3 mg elemental calcium per mL). * Oral calcium should be taken with food to enhance absorption. * In hydrofluoric acid burns, topical calcium gluconate is crucial to prevent deeper tissue damage and systemic toxicity. *** *Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines for definitive guidance. Dosing and recommendations may vary based on patient-specific factors and local protocols.*