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# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt used primarily to manage hypocalcemia or as a cardioprotective agent in hyperkalemia. It provides 93 mg of elemental calcium per 1 gram of calcium gluconate (approx. 4.65 mEq calcium). ## Primary Indications * Acute symptomatic hypocalcemia (tetany, seizures, prolonged QTc). * Cardiac membrane stabilization in severe hyperkalemia. * Antidote for 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 calcium levels. * **Hyperkalemia:** 1–2 g IV over 5–10 minutes. May repeat if ECG changes persist after 5 minutes. * **Continuous Infusion:** 0.5–2 mg/kg/hour for severe or refractory cases (titrate to ionized calcium). ## Pediatric Dosing * **Hypocalcemia:** 50–100 mg/kg/dose (max 2 g/dose) IV slow infusion over 10–20 minutes. May repeat every 6 hours as needed. * **Hyperkalemia:** 50–100 mg/kg/dose (max 2 g/dose) IV over 5–10 minutes. * *Note: Dosing depends on local institutional protocol and degree of symptom severity.* ## Dose Adjustments * **Renal Impairment:** Reduce frequency/dose in severe kidney disease to prevent hypercalcemia. * **Hepatic Impairment:** No specific adjustment necessary. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (due to risk of severe arrhythmias). * Avoid intramuscular or subcutaneous administration (high risk of tissue necrosis). ## Adverse Effects * **Common:** Hypotension, peripheral vasodilation, bradycardia (if infused too rapidly), local site irritation. * **Serious:** Tissue necrosis/sloughing (extravasation), cardiac arrhythmias, cardiac arrest (rapid IV push). ## Key Drug Interactions * **Digoxin:** Increased risk of digitalis-induced arrhythmia; avoid concurrent rapid infusion. * **Ceftriaxone:** Potential for precipitation when mixed in IV lines; avoid physical incompatibility (flush line well between administrations). * **Tetracyclines/Fluoroquinolones:** Calcium can chelate these drugs, reducing oral absorption. ## Monitoring * **Cardiac:** Continuous ECG monitoring during rapid IV administration. * **Laboratory:** Serum ionized calcium (preferred) or total calcium, magnesium, and phosphate. * **IV Site:** Closely monitor for signs of extravasation (pain, swelling, blanching). ## Clinical Pearls * **Administration:** Highly vesicant; use a large peripheral vein or central line. If extravasation occurs, stop infusion immediately and consider local sodium thiosulfate. * **Calcium Gluconate vs. Chloride:** Gluconate is preferred for peripheral administration as it is less irritating to veins than calcium chloride. Calcium chloride provides 3x more elemental calcium per gram than gluconate. * **Correction:** Always correct total calcium for hypoalbuminemia: Corrected Ca = Serum Ca + 0.8 × (4.0 - Serum Albumin). *** **Disclaimer:** This information is for educational purposes only. Verify all dosages, contraindications, and drug interactions against current institutional protocols and the official manufacturer prescribing information before administration.