Calcium Gliconate

# CALCIUM GLICONATE ## Overview - **Classification**: Electrolyte, Mineral Supplement, Antidote - **Mechanism**: Provides ionized calcium, essential for nerve/muscle function, bone formation, coagulation, and cardiac activity. Directly antagonizes cardiotoxic effects of hyperkalemia and magnesium toxicity. ## Primary Indications 1. **Hypocalcemia**: Treatment of acute, symptomatic hypocalcemia. 2. **Hyperkalemia**: Management of cardiac toxicity associated with severe hyperkalemia. 3. **Magnesium Toxicity**: Reversal of severe magnesium sulfate toxicity. 4. **Calcium Channel Blocker Overdose**: Antidote for severe overdose. ## Adult Dosing ### Standard Dosing **Acute Symptomatic Hypocalcemia** - **Dose**: **1-2 grams** (10-20 mL of 10% solution) - **Frequency**: Once, may repeat every **4-6 hours** as needed. - **Route**: IV slow infusion over **5-10 minutes**. - **Duration**: As clinically indicated. **Hyperkalemia with Cardiotoxicity** - **Dose**: **1-3 grams** (10-30 mL of 10% solution) - **Frequency**: Once, may repeat in **5-10 minutes** if ECG changes persist. - **Route**: IV slow infusion over **5-10 minutes**. **Magnesium Toxicity** - **Dose**: **1-2 grams** (10-20 mL of 10% solution) - **Frequency**: Once. - **Route**: IV slow infusion over **5-10 minutes**. **Calcium Channel Blocker Overdose** - **Dose**: **3-6 grams** (30-60 mL of 10% solution) - **Frequency**: Once, may repeat every **10-20 minutes** for persistent symptoms. - **Route**: IV slow infusion over **5-10 minutes**. ### Dose Adjustments - **Renal Impairment**: Use with caution. Monitor calcium levels closely due to impaired excretion. - **Hepatic Impairment**: No specific adjustments required. - **Elderly Patients**: Use with caution due to potential renal impairment and comorbidities. Start at lower end of dose range. ## Pediatric Dosing ### Neonates (0-28 days) **Acute Symptomatic Hypocalcemia** - **Dose**: **50-100 mg/kg** (0.5-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. - **Maximum**: **1 gram** (10 mL) per dose. - **Special Notes**: Avoid scalp vein infusion; infuse slowly to prevent bradycardia. **Hyperkalemia with Cardiotoxicity** - **Dose**: **60-100 mg/kg** (0.6-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. May repeat in 5-10 min if ECG changes persist. - **Maximum**: **1 gram** per dose. ### Infants (1-12 months) **Acute Symptomatic Hypocalcemia** - **Dose**: **50-100 mg/kg** (0.5-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. - **Maximum**: **1 gram** (10 mL) per dose. **Hyperkalemia with Cardiotoxicity** - **Dose**: **60-100 mg/kg** (0.6-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. May repeat in 5-10 min if ECG changes persist. - **Maximum**: **3 grams** per dose. ### Children (1-12 years) **Acute Symptomatic Hypocalcemia** - **Dose**: **50-100 mg/kg** (0.5-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. - **Maximum**: **3 grams** (30 mL) per dose. **Hyperkalemia with Cardiotoxicity** - **Dose**: **60-100 mg/kg** (0.6-1 mL/kg of 10% solution) - **Frequency**: Once, over **5-10 minutes**. May repeat in 5-10 min if ECG changes persist. - **Maximum**: **3 grams** per dose. ### Adolescents (13-18 years) - **Dose**: Approach adult dosing. - **Maximum**: Adult dose maximums apply. - **Special Notes**: Monitor closely for cardiac effects and serum calcium. ## Safety Information ### Contraindications - **Absolute**: Hypercalcemia (pre-existing elevated calcium levels). - **Absolute**: Ventricular fibrillation. - **Absolute**: Digitalis toxicity (risk of serious arrhythmias). - **Absolute**: Concomitant IV Ceftriaxone in neonates (risk of precipitation). ### Common Adverse Effects - **Very Common (>10%)**: Local irritation, burning, warmth at injection site. - **Common (1-10%)**: Vasodilation, flushing, nausea, vomiting, dizziness. - **Serious but Rare**: Hypercalcemia (arrhythmias, confusion, coma), rapid IV injection (bradycardia, hypotension, syncope), extravasation (tissue necrosis, calcification). ### Key Drug Interactions - **Digitalis (Digoxin)**: Greatly increased risk of serious arrhythmias; contraindicated. - **Thiazide Diuretics**: May increase serum calcium levels due to decreased calcium excretion. - **Phosphate (IV)**: Forms insoluble precipitate; do not administer simultaneously. - **Ceftriaxone (Neonates)**: Contraindicated; risk of fatal calcium-ceftriaxone precipitation in organs. ## Monitoring & Follow-up - **Before Treatment**: Baseline serum calcium (total and ionized), potassium, magnesium, renal function, ECG. - **During Treatment**: Continuous ECG monitoring (especially with rapid IV), frequent serum calcium levels, vital signs (BP, HR). - **Clinical Signs**: Monitor for resolution of symptoms, signs of hypercalcemia (lethargy, polyuria), or extravasation. ## Clinical Pearls - 💡 **Tip 1**: Always administer IV calcium gluconate slowly (over **5-10 minutes**) to minimize cardiac adverse effects (bradycardia, hypotension). - 💡 **Tip 2**: Calcium gluconate is preferred over calcium chloride for peripheral IV administration due to a lower risk of tissue necrosis if extravasation occurs. - 💡 **Tip 3**: Calcium for hyperkalemia is cardioprotective, but does NOT lower potassium; other potassium-lowering agents are required. - 💡 **Tip 4**: For continuous infusions, dilute calcium gluconate to prevent vein irritation and ensure safe delivery. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.