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# Calcium Gluconate ## Overview Calcium gluconate is an intravenous (IV) or oral calcium salt used to restore serum calcium levels or stabilize the cardiac membrane. It is preferred over calcium chloride for peripheral administration due to a lower risk of tissue necrosis if extravasation occurs. ## Primary Indications * Severe, symptomatic hypocalcemia. * Hyperkalemia-induced cardiac toxicity (membrane stabilization). * Hypermagnesemia or calcium channel blocker toxicity. * Adjunct in cardiac resuscitation (only if hyperkalemia, hypocalcemia, or CCB toxicity is suspected). ## Adult Dosing * **Hypocalcemia:** 1–2 grams IV infused over 30–60 minutes. May repeat every 6 hours as needed based on serum calcium levels. * **Cardiac Membrane Stabilization (Hyperkalemia):** 1–2 grams IV push over 5–10 minutes. May repeat in 5 minutes if ECG changes persist. * **Dosing Warning:** Doses are typically expressed as grams of calcium gluconate. 1g calcium gluconate provides ~90mg (4.6 mEq) of elemental calcium. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (or 0.5–1 mL/kg of 10% solution) IV slow infusion over 30–60 minutes. * **Cardiac Emergency:** 50–100 mg/kg/dose IV push (max 1g/dose) over 5–10 minutes. * *Note: Always verify doses with weight-based institutional protocols, as concentrations and infusion rates vary.* ## Dose Adjustments * **Renal Impairment:** Reduce frequency; no fixed dose reduction, but monitor serum calcium frequently to avoid hypercalcemia. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation (during cardiac resuscitation). * Hypercalcemia. * Digitalis toxicity (increased risk of severe arrhythmias). ## Adverse Effects * **Local:** Extravasation can cause severe tissue necrosis, sloughing, and calcification (less risk than calcium chloride). * **Systemic:** Rapid infusion may cause bradycardia, hypotension, syncope, or cardiac arrhythmias. * **General:** Chalky taste, tingling/warmth (with rapid infusion), constipation (if oral). ## Key Drug Interactions * **Digoxin:** Calcium accelerates digitalis toxicity; avoid parenteral calcium in patients on digitalis unless absolutely necessary for life-saving stabilization. * **Ceftriaxone:** Physical incompatibility; formation of ceftriaxone-calcium precipitates in the lungs and kidneys can be fatal, particularly in neonates. Flush lines thoroughly between these drugs. * **Admixtures:** Incompatible with many drugs, including phosphates, bicarbonates, and tetracyclines. ## Monitoring * **ECG:** Continuous monitoring if giving IV push for cardiac stabilization. * **Laboratory:** Serum ionized calcium (preferred) or total calcium, serum magnesium, and potassium levels. * **Site:** Monitor IV site closely for signs of extravasation. ## Clinical Pearls * Calcium gluconate must not be mixed with sodium bicarbonate or phosphate-containing solutions to prevent precipitation. * If extravasation occurs, stop the infusion immediately, elevate the limb, and consider hyaluronidase infiltration if significant tissue damage is suspected. * Always distinguish between calcium gluconate and calcium chloride; calcium chloride contains ~3 times more elemental calcium per gram and is highly irritating to peripheral veins. *** *Disclaimer: This information is for educational purposes only. Clinical practice and institutional protocols vary. Always consult your current institutional guidelines and the product-specific prescribing information before administering medications.*