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# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt providing elemental calcium. It is preferred over calcium chloride for peripheral administration due to lower risk of tissue necrosis if extravasation occurs. 1 gram of calcium gluconate provides approximately 90 mg (4.65 mEq) of elemental calcium. ## Primary Indications * Acute symptomatic hypocalcemia. * Hyperkalemia-induced cardiotoxicity (stabilizes cardiac membrane). * Magnesium sulfate toxicity. * Calcium channel blocker or hydrofluoric acid exposure. ## Adult Dosing * **Hypocalcemia:** 1–2 grams (10–20 mL of 10% solution) IV slow bolus; can be followed by continuous infusion of 0.5–2 mg/kg/hour based on serum levels. * **Hyperkalemia/Emergencies:** 1–2 grams (10–20 mL of 10% solution) IV over 5–10 minutes. May repeat every 5–10 minutes if ECG changes persist. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (1–2 mL/kg/dose of 10% solution) IV slow bolus. Avoid exceeding 2 grams per dose. * **Emergencies:** 50–100 mg/kg/dose (0.5–1 mL/kg/dose of 10% solution) IV slow bolus. ## Dose Adjustments * **Renal Impairment:** Use with caution; monitor serum calcium closely. * **Hepatic Impairment:** No specific adjustments required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (due to potential for arrhythmias). * Hypophosphatemia (risk of calcium-phosphate precipitation). ## Adverse Effects * **Common:** Hypotension, bradycardia, or arrhythmias (if infused too rapidly). * **Local:** Injection site reaction, burning, or necrosis if extravasation occurs. * **Severe:** Cardiac arrest, syncope. ## Key Drug Interactions * **Digoxin:** Increases risk of digitalis toxicity; risk of fatal arrhythmias. * **Ceftriaxone:** Fatal precipitation in IV lines; do not co-administer, especially in neonates. * **Tetracyclines/Fluoroquinolones:** Calcium decreases absorption/efficacy. * **Thiazide Diuretics:** Increase the risk of hypercalcemia. ## Monitoring * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Laboratory:** Serum ionized calcium (preferred) or total calcium; serum magnesium and phosphorus levels. * **Site:** Observe for erythema or infiltration at infusion site. ## Clinical Pearls * **Rate of Administration:** Maximum infusion rate is generally 200 mg/min; extreme caution required to prevent cardiac arrest. * **Compatibility:** Highly prone to precipitation if mixed with carbonate, phosphate, sulfate, or tartrate solutions. Flush lines thoroughly before and after administration. * **Extravasation:** Requires immediate cessation of infusion. Consult institutional protocols for rescue therapy (e.g., sodium thiosulfate). * **Protocol Dependency:** Dosing for hyperkalemia and acute hypocalcemia may vary significantly based on local institutional guidelines or ACLS algorithms. *** *Disclaimer: This information is for educational purposes only. Always verify dosages, contraindications, and drug interactions against current institutional protocols, the package insert, and pharmacopeia resources before prescribing or administering medication.*