Calcium%2520gliconate

# Calcium gluconate ## Overview Calcium gluconate is a mineral salt used to treat or prevent hypocalcemia. It contains approximately 9% elemental calcium (93 mg per gram). It is less irritating than calcium chloride for peripheral administration. ## Primary Indications - Acute symptomatic hypocalcemia (e.g., tetany, seizures, laryngospasm) - Cardiac arrest due to hyperkalemia, hypermagnesemia, or calcium channel blocker overdose - Severe hypermagnesemia - Electrolyte supplementation in total parenteral nutrition or massive transfusion ## Adult Dosing - **Acute hypocalcemia (IV):** 1–2 grams (10–20 mL of 10% solution) IV over 10–20 minutes. May repeat based on serum calcium. - **Continuous infusion:** 0.5–2 mg/kg/hr of elemental calcium (use if symptomatic or recalcitrant). Dose depends on protocol. - **Cardiac arrest (hyperkalemia/CCB OD):** 1 gram (10 mL of 10% solution) IV push; may repeat once. - **Hypocalcemia prevention in TPN:** Add 10–15 mEq per day; adjust per serum levels. ## Pediatric Dosing - **Acute hypocalcemia (IV):** 100–200 mg/kg/dose (1–2 mL/kg of 10% solution) IV over 5–10 minutes. **Max: 1–2 g per dose**. - **Neonatal hypocalcemia:** 100–200 mg/kg/dose (0.5–1 mL/kg of 10% solution) slow IV. Use with caution; monitor for bradycardia. - **Cardiac arrest:** 20–50 mg/kg (0.2–0.5 mL/kg) IV; max 1 g. ## Dose Adjustments - **Renal impairment:** Risk of hypercalcemia; avoid unless hypocalcemic. Adjust dose to avoid calcium > upper normal limit. - **Hepatic impairment:** No specific adjustment. ## Contraindications - Hypercalcemia - Severe hypercalciuria (e.g., nephrolithiasis) - Digitalis toxicity (relative; use with extreme caution) - Ventricular fibrillation (unless hyperkalemia/CCB OD) ## Adverse Effects - **IV administration:** Tissue necrosis with extravasation (use large vein), hypotension, bradycardia. Avoid rapid IV push. - **General:** Constipation, nausea, hypercalcemia (weakness, bone pain, polyuria, confusion). ## Key Drug Interactions - **Digitalis glycosides:** Increased toxicity; monitor ECG and calcium levels. - **Thiazide diuretics:** Increased risk of hypercalcemia. - **Corticosteroids:** Decreased calcium absorption; may reduce hypocalcemic effect. - **Fluoroquinolones, tetracyclines:** Reduced absorption if given concurrently (separate by 2 hours). ## Monitoring - Serum ionized calcium (preferred), total calcium, albumin, and corrected calcium (if indicated). - ECG for QT changes or arrhythmia. - IV site for extravasation. ## Clinical Pearls - **Calcium gluconate vs chloride:** Chloride contains 3x more elemental calcium per mL; gluconate is less irritating for peripheral lines. - **Dilution:** For peripheral IV, 10% solution (1 gram/10 mL) is preferred; do not dilute in bicarbonate-containing fluids (precipitation risk). - **Dosing terminology:** Always confirm local protocol for "gram vs mEq vs mg" dosing. Check product labeling for specific salt (e.g., 10% solution = 100 mg/mL). --- **Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, product labeling, and local protocols before administering.