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# Calcium Gluconate
## Overview
Calcium gluconate is an intravenous (or oral, though less common) calcium salt used to restore serum calcium levels or provide cardioprotection against hyperkalemia. It contains approximately 9% elemental calcium (90 mg elemental calcium per 1 gram of calcium gluconate).
## Primary Indications
* Hypocalcemia (acute, symptomatic).
* Cardiac stabilization in hyperkalemia.
* Calcium channel blocker overdose or magnesium toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV administered slowly (not to exceed 200 mg/min). May repeat every 4–6 hours based on serum levels.
* **Hyperkalemia/Cardiac Stabilization:** 1–2 grams (10–20 mL of 10% solution) IV push over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Calcium Channel Blocker Overdose:** 2–6 grams IV bolus, followed by a continuous infusion (e.g., 0.5–1 mg/kg/hour). Local protocols vary widely for titration.
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV over 5–10 minutes. Repeat as necessary based on ionized calcium levels.
* **Hyperkalemia/Cardiac stabilization:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV over 5–10 minutes. Max single dose usually 2 grams.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment required, but use with caution; monitor serum calcium closely as hypercalcemia can occur.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Ventricular fibrillation.
* Hypercalcemia.
* Digoxin toxicity (can worsen arrhythmias; use with extreme caution if mandatory).
## Adverse Effects
* **Injection site:** Tissue necrosis and sloughing if extravasation occurs (calcium gluconate is less irritant than calcium chloride but still carries risk).
* **Cardiovascular:** Bradycardia, hypotension, or arrhythmias if infused too rapidly.
* **Gastrointestinal:** Chalky taste, nausea, or vomiting during infusion.
## Key Drug Interactions
* **Digoxin:** Increases risk of severe arrhythmias.
* **Ceftriaxone:** Physical incompatibility (precipitation); do not mix or administer via the same line within 48 hours in neonates.
* **Phosphate-containing solutions:** Potential for calcium-phosphate precipitation.
## Monitoring
* **ECG:** Constant monitoring during IV administration (watch for bradycardia or shortening of QT interval).
* **Serum Calcium:** Monitor ionized calcium levels to guide therapy.
* **Extravasation:** Frequent assessment of IV site patency.
## Clinical Pearls
* **Preparation:** Calcium gluconate is preferred over calcium chloride for peripheral venous access due to lower risk of severe tissue necrosis.
* **Extravasation Management:** If extravasation occurs, stop the infusion immediately and consider local injection of sodium thiosulfate (consult poison control or clinical pharmacist).
* **Infusion Rate:** Rapid administration carries a risk of hypotension, vasodilation, and cardiac arrest.
* **Note:** Dosing is highly protocol-dependent, especially in critical care units; always verify with institution-specific guidelines for CCB poisoning or massive transfusion protocols.
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*Disclaimer: This information is for educational purposes and does not substitute for clinical judgment. Always verify current prescribing information, institutional protocols, and patient-specific factors before administering any medication.*
