Calcium Gluconate

# Calcium gluconate ## Overview - **Classification**: Mineral/Electrolyte replacement, Antidote - **Mechanism**: Provides elemental calcium, essential for nerve/muscle function, bone calcification, and blood coagulation. Decreases cardiac excitability in hyperkalemia. ## Primary Indications 1. **Acute Hypocalcemia** - Symptomatic low calcium (e.g., tetany, seizures). 2. **Hyperkalemia-induced Cardiotoxicity** - Stabilizes cardiac membrane potentials. 3. **Magnesium Sulfate Toxicity** - Reverses neuromuscular effects. 4. **Hydrofluoric Acid (HF) Burns** - Neutralizes fluoride ions in tissue. 5. **Calcium Channel Blocker Overdose** - May improve cardiac contractility. ## Adult Dosing ### Standard Dosing **Acute Hypocalcemia/Hyperkalemia/Magnesium Toxicity/CCB Overdose** - **Dose**: **10-20 mL of 10% solution** (**1-2 grams**) - **Frequency**: Repeat as needed based on calcium levels or clinical response. - **Route**: Slow IV push or infusion over **10-20 minutes**. - **Special considerations**: Do not exceed **200 mg/minute** IV infusion rate. **Hydrofluoric Acid Burns (Topical/Local Infiltration)** - **Dose**: Apply **2.5% Calcium Gluconate Gel** topically. - **Frequency**: Continuously apply/reapply until pain resolved. - **Route**: Topical application. - **Special considerations**: For severe burns, **0.5 mL of 10% solution** injected per cm2 of affected area subcutaneously. ### Dose Adjustments - **Renal Impairment**: No specific dose adjustment, but use with caution. Risk of hypercalcemia increased. Monitor calcium levels closely. - **Hepatic Impairment**: No specific dose adjustment required. - **Elderly Patients**: No specific dose adjustment. Start at lower end of dosing range due to potential for decreased renal function and comorbidities. Monitor closely. ## Pediatric Dosing ### Neonates (0-28 days) - **Indication**: Acute symptomatic hypocalcemia. - **Dose**: **50-100 mg/kg (0.5-1 mL/kg of 10% solution)** - **Frequency**: Once, may repeat every **6-8 hours** if needed. - **Route**: Slow IV infusion over **30-60 minutes**. - **Maximum**: **1 gram/dose (10 mL of 10% solution)**. - **Special Notes**: Monitor heart rate continuously during infusion. Avoid rapid administration. ### Infants (1-12 months) - **Indication**: Acute symptomatic hypocalcemia. - **Dose**: **50-100 mg/kg (0.5-1 mL/kg of 10% solution)** - **Frequency**: Once, may repeat every **6-8 hours** if needed. - **Route**: Slow IV infusion over **30-60 minutes**. - **Maximum**: **1 gram/dose (10 mL of 10% solution)**. ### Children (1-12 years) - **Indication**: Acute symptomatic hypocalcemia. - **Dose**: **50-100 mg/kg (0.5-1 mL/kg of 10% solution)** - **Frequency**: Once, may repeat every **6-8 hours** if needed. - **Route**: Slow IV infusion over **30-60 minutes**. - **Maximum**: **3 grams/24 hours (30 mL of 10% solution)**. ### Adolescents (13-18 years) - **Indication**: Acute symptomatic hypocalcemia. - **Dose**: Follow adult dosing guidelines. - **Route**: Slow IV infusion over **10-20 minutes**. - **Maximum**: **3 grams/24 hours (30 mL of 10% solution)** initially, then tailored to response. ## Safety Information ### Contraindications - **Absolute**: Hypercalcemia - **Absolute**: Ventricular fibrillation (may worsen) - **Absolute**: Concomitant IV administration with Ceftriaxone in neonates (risk of fatal precipitation in lungs/kidneys). - **Relative**: Concomitant use with digoxin (increases risk of arrhythmias). ### Common Adverse Effects - **Common (1-10%)**: Warm sensation, vasodilation, injection site irritation. - **Serious but Rare**: Hypercalcemia (nausea, vomiting, confusion, coma), cardiac arrhythmias (bradycardia), extravasation with tissue necrosis, hypotension. ### Key Drug Interactions - **Digoxin**: Increased risk of digitalis toxicity (arrhythmias). Administer calcium very slowly and cautiously. - **Calcium Channel Blockers**: Calcium may reverse effects of CCBs. - **Thiazide Diuretics**: May decrease urinary calcium excretion, increasing risk of hypercalcemia. - **Phosphates/Carbonates/Sulfates**: May precipitate calcium salts. Avoid co-administration. ## Monitoring & Follow-up - **Before Treatment**: Baseline serum calcium, magnesium, potassium, renal function. ECG for patients with cardiac risk. - **During Treatment**: Continuous ECG monitoring during IV administration. Frequent serum calcium, magnesium, potassium levels. Vital signs (BP, HR). - **Clinical Signs**: Resolution of tetany, stabilization of cardiac rhythm, improvement in symptoms related to underlying condition. ## Clinical Pearls - 💡 **Slow Administration is Key**: Rapid IV injection can cause hypotension, bradycardia, or syncope. Infuse over **10-20 minutes** (adults) or **30-60 minutes** (pediatrics). - 💡 **Extravasation Risk**: Calcium gluconate is an irritant. Administer via central line if possible. Monitor injection site for pain, swelling, or redness. - 💡 **Not Interchangeable**: Calcium gluconate and calcium chloride are **not** interchangeable by volume. Calcium chloride provides ~3x more elemental calcium per volume. - 💡 **Warm Solution**: Warming the solution to body temperature can reduce venous irritation. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.