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# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt (approx. 9% elemental calcium) used for the treatment of hypocalcemia and as a cardioprotective agent in hyperkalemia. It is preferred over calcium chloride for peripheral administration to reduce the risk of tissue necrosis. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in hyperkalemia. * Calcium channel blocker or magnesium toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g IV administered over 10–20 minutes. May repeat every 4–6 hours as needed based on serum levels. * **Hyperkalemia/Cardioprotection:** 1–2 g IV push over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Max Rate:** Not to exceed 200 mg/minute (2 mL/minute of 10% solution) to prevent cardiac arrhythmias. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV slow bolus over 10–20 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose IV slow bolus. * *Note: Cardiac monitoring is mandatory during infusion; doses must be adjusted based on local institutional protocols.* ## Dose Adjustments * **Renal Impairment:** No standard dosage adjustment; however, use with extreme caution in patients with hyperphosphatemia, as calcium-phosphate precipitation may occur. * **Hepatic Impairment:** No adjustment required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (relative contraindication; calcium may precipitate severe arrhythmias). ## Adverse Effects * **Injection site:** Tissue necrosis/sloughing if extravasation occurs (manage with hyaluronidase). * **Cardiovascular:** Bradycardia, syncope, hypertension, or arrhythmia (if infused too rapidly). * **GI:** Chalky taste, nausea, or vomiting during infusion. ## Key Drug Interactions * **Ceftriaxone:** Concurrent use with calcium in neonates (<28 days) is absolutely contraindicated due to fatal precipitation. * **Digoxin:** Calcium increases myocardial sensitivity to digitalis; may precipitate severe digitalis toxicity. * **Phosphates:** Avoid concurrent IV delivery to prevent calcium-phosphate precipitation. ## Monitoring * **ECG:** Continuous monitoring during IV administration; stop immediately if bradycardia or arrhythmias occur. * **Electrolytes:** Ensure serum calcium and phosphorus concentrations are checked regularly. * **Site:** Carefully monitor the injection site for infiltration. ## Clinical Pearls * **Administration:** Ensure patency of the IV line before administration. Use a large vein; central line preferred, but peripheral is acceptable if delivery is slow. * **Elemental Calcium:** 1 g of calcium gluconate = 90 mg (4.65 mEq) of elemental calcium. * **Compatibility:** Highly incompatible with many drugs; flush lines thoroughly before/after administration. Do not mix with sodium bicarbonate. *** *Educational Disclaimer: This information is for educational purposes only. Always consult current institutional protocols and verify dosages/compatibility using primary references (e.g., Lexicomp, UpToDate) before prescribing or administering medication.*