Calcium%2525252525252525252525252525252525252525252525252525252525252525252520gluconate

# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt that provides elemental calcium. It is available in oral and intravenous (IV) formulations. ## Primary Indications * **Hypocalcemia:** Treatment of symptomatic hypocalcemia. * **Magnesium Sulfate Overdose:** IV calcium gluconate is the antidote for severe hypermagnesemia (e.g., due to magnesium sulfate overdose). * **Hydrofluoric Acid Exposure:** Topical or IV calcium gluconate can be used for hydrofluoric acid burns to precipitate fluoride ions. ## Adult Dosing * **Hypocalcemia (IV):** * 10% solution (100 mg/mL): Administer **10 mL (1 gram elemental calcium)** IV slowly over 10-20 minutes. May be repeated every 6 hours as needed based on serum calcium levels and clinical response. **Maximum dose is not strictly defined, but repeat doses should be guided by serum calcium levels.** Infusion rate should not exceed 1 mL/min (100 mg/min) to prevent hypotension and cardiac arrhythmias. * **Note:** In severe or symptomatic hypocalcemia, or when cardiac toxicity is present, higher doses may be administered, but this should be done with continuous cardiac monitoring. * **Hypocalcemia (Oral):** * Various formulations available (e.g., tablets, liquid). Typical doses range from **1 to 2 grams of elemental calcium per day**, divided into 2-4 doses. Dosage is highly individualized based on calcium deficiency and ongoing losses. * **Magnesium Sulfate Overdose (IV):** * 10% solution (100 mg/mL): **5 mL (500 mg elemental calcium)** IV, administered slowly while monitoring ECG. May be repeated every 1-2 minutes if needed, up to a total of 20 mL (2 grams elemental calcium). * **Hydrofluoric Acid Exposure (Topical):** Apply gel generously or soak affected area in calcium gluconate solution. * **Hydrofluoric Acid Exposure (IV):** For severe systemic toxicity, **10 mL (1 gram elemental calcium)** of 10% solution administered IV, as for hypocalcemia. ## Pediatric Dosing * **Hypocalcemia (IV):** * 10% solution (100 mg/mL): **0.5 to 1 mL/kg (50-100 mg elemental calcium/kg)** IV administered slowly over 10-20 minutes. May be repeated every 6 hours as needed based on serum calcium levels and clinical response. **Maximum dose not strictly defined; guided by serum calcium and clinical status.** Infusion rate should not exceed 0.1 mL/kg/min (10 mg/kg/min) to prevent hypotension. * **Hypocalcemia (Oral):** * Dosing varies widely based on age and severity of deficiency. Typically ranges from **15-75 mg/kg/day of elemental calcium**, divided into 3-4 doses. Specific recommendations depend on local pediatric protocols. * **Hydrofluoric Acid Exposure (Topical):** Apply gel generously or soak affected area in calcium gluconate solution. * **Hydrofluoric Acid Exposure (IV):** For severe systemic toxicity, **0.5 mL/kg (50 mg elemental calcium/kg)** of 10% solution administered IV, as for hypocalcemia. ## Dose Adjustments * **Renal Impairment:** No specific dose adjustment is typically required for IV administration when treating acute hypocalcemia. However, caution is advised in severe renal impairment as hypercalcemia can occur with repeated or high doses. Oral calcium absorption may be impaired. ## Contraindications * **Hypercalcemia:** Do not administer to patients with hypercalcemia. * **Ventricular Fibrillation:** IV administration is contraindicated in patients with ventricular fibrillation. * **Certain Renal Calculi:** Patients with a history of calcium-containing renal calculi should be monitored closely. * **Sarcoidosis:** Patients with sarcoidosis may be more sensitive to the effects of calcium. ## Adverse Effects * **IV:** Hypotension, bradycardia, arrhythmias, vasodilation, phlebitis, tissue necrosis (if extravasation occurs), hypercalcemia. Rapid IV injection can cause burning sensation, tingling, and chalky taste. * **Oral:** Constipation, nausea, vomiting, abdominal discomfort. Hypercalcemia with prolonged use or excessive doses. ## Key Drug Interactions * **Digoxin:** IV calcium can potentiate digoxin toxicity. Monitor closely and avoid if possible. * **Tetracyclines and Quinolones:** Oral calcium can decrease absorption of these antibiotics by forming insoluble complexes. Separate administration by at least 2-4 hours. * **Bisphosphonates and Thyroid Hormones:** Oral calcium can decrease absorption. Separate administration by at least 2-4 hours. * **Thiazide Diuretics:** Can increase serum calcium levels and risk of hypercalcemia. * **Vitamin D Analogs:** Enhance calcium absorption and increase the risk of hypercalcemia. ## Monitoring * **Serum Calcium Levels:** Essential for guiding IV and oral dosing and assessing effectiveness. Corrected calcium levels (adjusted for albumin) are often preferred. * **ECG:** Especially important during rapid IV administration or in patients with cardiac compromise, to monitor for arrhythmias or signs of hypercalcemia. * **Renal Function:** Monitor for signs of nephrocalcinosis with prolonged or high-dose therapy. * **Signs and Symptoms of Hypocalcemia/Hypercalcemia:** Monitor for muscle twitching, tetany, paresthesias, cardiac changes, and gastrointestinal distress. ## Clinical Pearls * **IV Administration:** Always administer IV calcium gluconate slowly and with ECG monitoring, especially in patients with cardiac issues. **Never administer IV calcium chloride and calcium gluconate simultaneously as they can precipitate.** Calcium gluconate is less irritating than calcium chloride. * **Extravasation:** If extravasation of IV calcium occurs, it can cause severe tissue necrosis. Stop infusion and infiltrate the area with hyaluronidase if available. * **Oral vs. IV:** Oral calcium gluconate has lower elemental calcium content (9%) compared to calcium carbonate (40%) and is often used when a less constipating option is desired or in the presence of achlorhydria. * **Albumin Correction:** When interpreting serum calcium levels, consider correcting for albumin concentration if the patient's albumin level is outside the normal range. *** **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 relevant clinical guidelines before making any treatment decisions. Dosing and recommendations may vary based on individual patient factors and local institutional protocols.