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# Calcium Gluconate ## Overview Calcium gluconate is a parenteral calcium salt used to manage hypocalcemia and hyperkalemia. It provides a lower calcium ion concentration per milliliter (approximately 9 mg elemental calcium/mL) compared to calcium chloride, making it safer for peripheral administration. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia. * Calcium channel blocker overdose or magnesium toxicity. * Adjunct in cardiac resuscitation (only if hyperkalemia, hypocalcemia, or CCB toxicity is suspected). ## Adult Dosing * **Hypocalcemia:** 1–2 g IV infusion over 10–20 minutes. May repeat every 4–6 hours as needed based on serum calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 g IV over 5–10 minutes. May be repeated after 5 minutes if ECG abnormalities persist. * **CCB Toxicity:** 1–3 g IV bolus; may repeat or follow with continuous infusion (0.5–1.5 mg/kg/hour). * **Note:** Always verify dosing against local hospital protocols, as concentrations (usually 10%) and infusion rates vary by clinical setting. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose IV over 10–20 minutes. Maximum single dose: 2 g. * **Hyperkalemia (Cardioprotection):** 100 mg/kg/dose (max 2 g) IV administered over 5–10 minutes. * *Consult neonatal/pediatric advanced life support (PALS) guidelines for high-risk neonates.* ## Dose Adjustments * **Renal Impairment:** No standard dosage adjustment; however, monitor closely for hypercalcemia if renal clearance is impaired. * **Hepatic Impairment:** No official adjustment required. ## Contraindications * Ventricular fibrillation. * Hypercalcemia. * Digitalis toxicity (increased risk of arrhythmias). * Concurrent administration in the same IV line as phosphate-containing solutions (risk of precipitation). ## Adverse Effects * **Local:** Extravasation/tissue necrosis (less common than with calcium chloride). * **Systemic:** Bradycardia, syncope, hypotension, flushing, and metallic taste. Rapid IV administration may induce cardiac arrhythmias. ## Key Drug Interactions * **Digoxin:** Calcium synergistically increases digoxin toxicity; avoid or administer with extreme caution in patients on digitalis. * **Ceftriaxone:** Fatal precipitation in patients of all ages; do not administer in the same line or within 48 hours of each other. * **Tetracyclines/Fluoroquinolones:** Calcium can chelate these drugs, reducing their absorption/efficacy. ## Monitoring * **Cardiac:** Continuous ECG monitoring during IV administration (watch for bradycardia or QTc shortening). * **Labs:** Serum ionized calcium levels, potassium, and magnesium. * **Site:** Monitor IV site for signs of extravasation or infiltration. ## Clinical Pearls * **Calcium Gluconate vs. Chloride:** Calcium chloride provides 3x more elemental calcium but is highly sclerosing. Use gluconate for peripheral access whenever possible. * **Administration:** In emergencies, administer slowly. If the patient is not in cardiac arrest, limit infusion rate to 200 mg/min max. * **Incompatibility:** Flush lines thoroughly with normal saline before and after administration of other medications to prevent precipitation. *** **Educational Disclaimer:** This information is for educational purposes only and does not supersede local institutional protocols. Verify all dosages, infusion rates, and compatibility data against the manufacturer’s product insert or a current clinical drug reference (e.g., Lexicomp, Micromedex) before prescribing or administering.