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# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt that provides calcium, an essential mineral for numerous physiological functions, including bone health, nerve conduction, muscle contraction, and cardiac function. ## Primary Indications * Treatment of hypocalcemia (serum calcium < 8.5 mg/dL). * Adjunctive treatment for acute hyperkalemia. * Treatment of acute hypermagnesemia. * Antidote for toxic effects of magnesium sulfate, calcium channel blockers, and fluoride poisoning. ## Adult Dosing * **Hypocalcemia:** * **Intravenous (IV):** 10 mL of 10% calcium gluconate solution (100 mg elemental calcium) infused over 10-20 minutes. Repeat as needed based on serum calcium levels and clinical response. Alternatively, 1 gram (10 mL of 10% solution) elemental calcium may be administered every 6-12 hours. * **Oral:** Dosing varies widely based on severity and underlying cause. Common regimens include 1-2 grams of elemental calcium (e.g., 10-20 mL of 10% solution if concentrated enough, or specific oral formulations) given 2-4 times daily. * **Hyperkalemia:** 10 mL of 10% calcium gluconate IV infused over 5-10 minutes. *This does not lower potassium levels but protects the myocardium from potassium's effects.* Repeat every 5 minutes if needed based on ECG changes. * **Hypermagnesemia:** 10-20 mL of 10% calcium gluconate IV infused over 5-10 minutes. Repeat as needed. * **Calcium Channel Blocker Overdose:** 1 gram (10 mL of 10% solution) IV every 5 minutes, potentially up to 3 grams, with serial ECG monitoring. * **Fluoride Poisoning:** 10-20 mL of 10% calcium gluconate IV, followed by infusion of 100 mL of 10% solution over 1 hour. Further doses may be necessary. ## Pediatric Dosing * **Hypocalcemia:** * **Intravenous (IV):** 0.5-1 mL/kg of 10% calcium gluconate (50-100 mg elemental calcium/kg) infused over 10-20 minutes. Maximum infusion rate is 5 mL/min. May be followed by continuous infusion of 0.1-0.2 mL/kg/hr (10-20 mg/kg/hr) elemental calcium. Dosing must be guided by serum calcium levels and clinical response. * **Oral:** Dosing varies widely. Consult pediatric guidelines or specialist. * **Hyperkalemia:** 0.5-1 mL/kg of 10% calcium gluconate IV infused over 5-10 minutes. *Does not lower potassium levels.* * **Hypermagnesemia:** 0.2-0.4 mL/kg of 10% calcium gluconate IV infused over 5-10 minutes. * **Calcium Channel Blocker Overdose:** 0.1-0.2 mL/kg of 10% calcium gluconate IV every 5-10 minutes. ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, but serum calcium levels should be closely monitored. In severe renal impairment, calcium may accumulate. ## Contraindications * Hypercalcemia. * Ventricular fibrillation. * Renal calculi (relative contraindication, use with caution). * Certain patients with sarcoidosis or hyperparathyroidism (risk of severe hypercalcemia). * Do not administer intramuscularly (can cause tissue necrosis). * Do not administer subcutaneously. ## Adverse Effects * **Intravenous:** Hypotension, bradycardia, cardiac arrhythmias, cardiac arrest, peripheral vasodilation, local tissue irritation or necrosis (if extravasation occurs), tingling, chalky taste, heat sensation. * **Oral:** Constipation, nausea, vomiting, abdominal discomfort. ## Key Drug Interactions * **Thiazide Diuretics:** Increased risk of hypercalcemia. * **Digoxin:** Hypercalcemia increases the risk of digoxin toxicity. * **Tetracyclines and Fluoroquinolones:** Calcium gluconate can decrease the absorption of these antibiotics; separate administration by at least 2-4 hours. * **Bisphosphonates, Sodium Fluoride, Antacids:** Calcium can decrease the absorption of these medications. * **Calcium Channel Blockers:** IV calcium can antagonize the effects of calcium channel blockers. * **Phosphate-containing solutions:** Risk of calcium phosphate precipitation. ## Monitoring * Frequent serum calcium levels (ionized calcium is preferred). * ECG monitoring, especially during IV administration for hyperkalemia or cardiac conditions. * Magnesium levels if treating hypermagnesemia. * Renal function. ## Clinical Pearls * IV calcium gluconate should be administered slowly to prevent hypotension and arrhythmias. * Never administer IV calcium faster than 5 mL/min (500 mg elemental calcium/min) due to risk of cardiac arrest. * Use central venous access for prolonged infusions if possible. * Extravasation of IV calcium gluconate can cause severe tissue damage; antidote is hyaluronidase injection. * Ensure adequate magnesium levels, as hypomagnesemia can impair the effectiveness of calcium therapy and is often associated with hypocalcemia. * Oral calcium formulations are not bioequivalent; doses are typically expressed as elemental calcium. *** *Disclaimer: This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and relevant clinical guidelines for definitive patient management. Dosing and protocols may vary based on institutional policies and patient-specific factors.*