Calcium%252520gliconate

# Calcium Gluconate ## Overview Calcium gluconate is a parenteral calcium salt used to manage hypocalcemia and hyperkalemia. It contains approximately 90 mg of elemental calcium per 1 g of calcium gluconate (significantly less elemental calcium than calcium chloride). ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia. * Calcium channel blocker overdose or magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g IV administered over 10–20 minutes. May repeat after 6 hours or follow with a continuous infusion titrated to serum ionized calcium. * **Hyperkalemia (Cardioprotection):** 1–2 g IV over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist. * **Maximum:** Follow institutional protocols; typically avoid rapid injection to prevent cardiac arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (max 2 g/dose) IV infusion over 10–20 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose (max 2 g/dose) IV infusion over 5–10 minutes. * *Note: Always verify concentration (10% solution = 100 mg/mL).* ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but use with caution; monitor serum calcium levels closely to avoid hypercalcemia. * **Hepatic Impairment:** No dose adjustment required. ## Contraindications * Ventricular fibrillation (during CPR). * Digitalis toxicity (may worsen arrhythmias). * Hypercalcemia. * Severe renal impairment (relative contraindication; requires frequent monitoring). ## Adverse Effects * **Common:** Peripheral vasodilation, hypotension, bradycardia (if infused too rapidly), metallic taste. * **Serious:** Tissue necrosis/sloughing (if extravasation occurs), cardiac arrest (arrhythmia), hypercalcemia, constipation (if PO). ## Key Drug Interactions * **Ceftriaxone:** Physical incompatibility; never infuse through the same line or within 48 hours of each other (risk of fatal calcium-ceftriaxone precipitate). * **Digoxin:** Calcium can potentiate digitalis toxicity; use caution in patients on digoxin. * **Tetracyclines/Fluoroquinolones:** Calcium impairs absorption and may decrease serum concentrations of these antibiotics. ## Monitoring * **Parameters:** Continuous cardiac monitoring during IV administration. * **Laboratory:** Serum total and ionized calcium (ionized is preferred for clinical status), potassium, and phosphate. * **Clinical:** Monitor for extravasation at the infusion site. ## Clinical Pearls * **Extravasation Risk:** Calcium gluconate is less vesicant than calcium chloride but still carries a risk of tissue necrosis. Administer into a large vein to avoid extravasation. * **Calcium Gluconate vs. Chloride:** 1 g of calcium chloride provides 272 mg elemental calcium, whereas 1 g of calcium gluconate provides only 90 mg. Calcium gluconate is preferred in peripherally administered settings. * **pH:** Calcium gluconate is slightly acidic; ensure compatibility with Y-site medications. *** **Educational Disclaimer:** This information is for educational purposes only. Clinical practice varies by institution; always verify current prescribing information, institutional guidelines, and patient-specific factors before administration.