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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to manage hypocalcemia and hyperkalemia. It provides a lower concentration of elemental calcium (approx. 90 mg or 4.65 mEq per 1 gram) compared to calcium chloride, making it safer for peripheral administration.
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemic cardiac membrane stabilization (does not lower potassium, but protects the myocardium).
* Calcium channel blocker overdose or magnesium toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams administered IV over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels.
* **Cardiac Membrane Stabilization (Hyperkalemia):** 1–2 grams IV administered over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Calcium Channel Blocker Overdose:** 1–2 grams IV bolus, often followed by a continuous infusion titrated to effect.
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose (as 10% solution) IV infused over 10–20 minutes.
* **Emergency (Hyperkalemia/Cardiac):** 50–100 mg/kg/dose (max 2 grams) IV over 5–10 minutes.
* *Note: Dosing should be based on local hospital protocols as pediatrics require precision based on corrected calcium and ionic status.*
## Dose Adjustments
* **Renal Impairment:** No specific adjustment necessary, but monitor levels closely to avoid hypercalcemia.
* **Hepatic Impairment:** No specific adjustment necessary.
## Contraindications
* Ventricular fibrillation (during CPR, calcium is generally avoided unless hyperkalemia or hypocalcemia is confirmed).
* Digitalis toxicity (increased risk of severe arrhythmias).
* Hypercalcemia.
## Adverse Effects
* **Extravasation:** Can cause severe tissue necrosis and sloughing (ensure patency of IV line; use central line if possible for high concentrations).
* **Rapid Infusion:** Bradycardia, hypotension, syncope, or cardiac arrhythmias.
* **Local:** Burning sensation at the injection site.
## Key Drug Interactions
* **Digoxin:** Increases risk of digitalis-induced arrhythmia; avoid or cautiously administer if necessary.
* **Ceftriaxone:** Physical incompatibility; formation of insoluble calcium-ceftriaxone precipitates can occur. **Do not mix or administer simultaneously in the same line.** Flush lines thoroughly between medications.
* **Tetracyclines/Fluoroquinolones:** Calcium can significantly decrease the oral absorption of these drugs (if given concurrently).
## Monitoring
* **Serum Calcium:** Monitor ionized calcium levels.
* **ECG:** Continuous cardiac monitoring during IV infusion.
* **Site assessment:** Inspect for signs of extravasation (erythema, infiltration, pain).
## Clinical Pearls
* **Peripheral vs Central:** Calcium gluconate is preferred over calcium chloride for peripheral venous access because it is significantly less irritating if extravasation occurs.
* **Standard Concentration:** Usually supplied as a 10% solution (100 mg/mL).
* **Infusion Rate:** Always infuse slowly to prevent severe hypotension or cardiac arrest.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical protocols, dosing guidelines, and institutional policies vary. Always verify current prescribing information, compatibility charts, and local hospital protocols before administration.
