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# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt used primarily to restore serum calcium levels and to provide cardioprotection in the setting of hyperkalemia. It provides less elemental calcium (approx. 9% or 93 mg per 1 g of calcium gluconate) compared to calcium chloride. ## Primary Indications * Hypocalcemia (acute/symptomatic). * Hyperkalemia with EKG changes (cardioprotection). * Calcium channel blocker overdose. * Magnesium sulfate toxicity. ## Adult Dosing * **Hypocalcemia:** 1–2 g IV infused over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 g IV pushed slowly over 5–10 minutes. May repeat every 5 minutes if EKG changes persist. * **Dosing Note:** Always verify local institutional protocols, as some facilities prefer calcium chloride for central line administration to achieve faster, higher serum concentrations. ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV slow push over at least 10 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose IV slow push. * **Maximum:** Do not exceed 2 g per dose in pediatric patients unless directed by a specialist. ## Dose Adjustments * **Renal Impairment:** No standard dosage adjustment, but use with caution; monitor serum calcium and phosphorus closely for metastatic calcification risk. * **Hepatic Impairment:** No specific adjustment required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Hypercalciuria. * Digoxin toxicity (relative; calcium may increase risk of arrhythmias in the presence of digitalis). ## Adverse Effects * **Local (Injection site):** Tissue necrosis, sloughing, or extravasation injury (especially if extravasated—treat with hyaluronidase). * **Systemic:** Rapid infusion may cause bradycardia, arrhythmias (including asystole), syncope, flushing, hypotension, and a metallic taste. ## Key Drug Interactions * **Digoxin:** Increases risk of severe digitalis toxicity/arrhythmias; monitor EKG closely. * **Ceftriaxone:** Physical incompatibility; never infuse together or through the same line (risk of fatal calcium-ceftriaxone precipitate). * **Bisphosphonates:** Decreased absorption/efficacy. * **Calcium-containing products:** Concurrent use increases risk of hypercalcemia. ## Monitoring * **Clinical:** EKG (especially in hyperkalemia or suspected digitalis use), infusion site (monitor for extravasation). * **Laboratory:** Serum total and ionized calcium, serum magnesium, phosphate, and potassium. ## Clinical Pearls * **Administration:** Ideally administered via central line to reduce the risk of tissue necrosis. If peripheral administration is necessary, use a large vein and ensure confirmed patency. * **Compatibility:** Highly incompatible with many drugs. Always flush the line thoroughly between medications. * **Hypomagnesemia:** If hypocalcemia is refractory, check and correct magnesium levels, as hypomagnesemia can impair parathyroid hormone release and action. *** *Disclaimer: This information is for educational purposes only and does not replace professional clinical judgment. Always consult current institutional protocols, official prescribing information, and clinical decision support tools before prescribing or administering medication.*