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# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt providing elemental calcium. It is less irritating to tissues than calcium chloride, making it the preferred choice for peripheral administration. It is commonly used for acute hypocalcemia and to antagonize the cardiac membrane effects of hyperkalemia. ## Primary Indications * Severe symptomatic hypocalcemia. * Adjunctive therapy in cardiac arrest or severe bradycardia associated with hyperkalemia, hypermagnesemia, or calcium channel blocker toxicity. * Prevention of hypocalcemia during rapid blood transfusion (e.g., exchange transfusion). ## Adult Dosing * **Hypocalcemia:** 1–2 g IV infused slowly over 15–30 minutes. May repeat every 6 hours based on clinical response and serum calcium levels. * **Hyperkalemia-associated cardiotoxicity:** 1–2 g IV administered over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Emergency cardiac arrest:** 1–2 g IV push. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV slow bolus over 10–20 minutes. Max single dose: 2 g. * **Hyperkalemia / Hypermagnesemia / CCB Toxicity:** 50–100 mg/kg/dose IV slow bolus. ## Dose Adjustments * **Renal Impairment:** Use with caution in patients with chronic kidney disease (CKD); monitor serum calcium and phosphate levels closely to avoid hypercalcemia and metastatic calcification. * **Hepatic Impairment:** No specific dosage adjustments established. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (relative contraindication; calcium may precipitate severe arrhythmias). * Concurrent use of ceftriaxone in neonates (≤28 days) due to risk of fatal calcium-ceftriaxone precipitate in lungs and kidneys. ## Adverse Effects * **Cardiovascular:** Bradycardia, syncope, hypotension (if infused too rapidly). * **Local:** Extravasation can lead to tissue necrosis, sloughing, and abscess formation. * **Gastrointestinal:** Constipation, chalky taste. * **Metabolic:** Hypercalcemia, hypercalciuria. ## Key Drug Interactions * **Ceftriaxone:** Fatal precipitation in neonates; avoid concurrent use. * **Digoxin:** Calcium increases myocardial uptake of digoxin, enhancing its pharmacologic and toxic effects; use extreme caution. * **Tetracyclines/Fluoroquinolones:** Calcium can chelate these drugs, reducing their absorption/efficacy (administer 2–4 hours apart). ## Monitoring * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Laboratory:** Serum ionized calcium (preferred) or total calcium, magnesium, and phosphate. * **Site:** Regularly assess for signs of extravasation (erythema, pain, swelling). ## Clinical Pearls * **Preparation:** 1 g of calcium gluconate provides approximately 90 mg (4.65 mEq) of elemental calcium. * **Administration:** Slow infusion is critical to prevent hypotension, bradycardia, or cardiac arrest. Avoid IM or SC injection due to high risk of tissue necrosis. * **Extravasation:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor; consult a pharmacist or physician regarding the use of topical sodium thiosulfate if indicated by institutional protocol. * **Compatibility:** Highly incompatible with many drugs and solutions, particularly those containing carbonates, phosphates, or sulfates. Always flush the IV line between drug administrations. *** *Disclaimer: This information is for educational purposes for healthcare professionals. Dosages may vary based on institutional protocols, clinical judgment, and patient-specific factors. Always verify current prescribing information, package inserts, and local drug policies before administration.*