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# Calcium Gluconate
## Overview
Calcium gluconate is an intravenous calcium salt used to restore serum calcium levels and antagonize the membrane-stabilizing effects of hyperkalemia or calcium channel blocker toxicity. It provides less elemental calcium than calcium chloride (approx. 90 mg vs. 270 mg per 1 gram).
## Primary Indications
* Severe symptomatic hypocalcemia.
* Hyperkalemic cardiac membrane stabilization (ECG changes).
* Calcium channel blocker or magnesium sulfate toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infused over 10–20 minutes. May repeat every 6 hours as needed based on ionized calcium levels.
* **Hyperkalemia/Cardiac Stabilization:** 1–2 g IV push (or dilute in 50-100 mL D5W/NS) over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Maximum Rate:** Should not exceed 200 mg/min (to prevent arrhythmias/hypotension).
## Pediatric Dosing
* **Hypocalcemia/Emergency:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) slowly IV.
* **Note:** Dosing varies significantly based on acute vs. chronic condition and institutional protocol. Neonatal dosing requires specialized calculations to avoid tissue necrosis.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium/phosphorus closely as renal excretion is the primary clearance route for excess calcium.
* **Hepatic Impairment:** No specific adjustment necessary.
## Contraindications
* Ventricular fibrillation.
* Hypercalcemia.
* Digitalis toxicity (increased risk of severe arrhythmias).
* Concurrent administration with phosphate-containing solutions in the same IV line (precipitation risk).
## Adverse Effects
* **Extravasation:** Severe venous irritation and tissue necrosis (if extravasated).
* **Cardiovascular:** Bradycardia, arrhythmias, hypotension (if infused too rapidly).
* **GI:** Chalky taste, nausea/vomiting (with rapid infusion).
## Key Drug Interactions
* **Digoxin:** Calcium sensitizes the heart to digitalis, potentially inducing toxicity.
* **Ceftriaxone:** Fatal precipitation occurs if mixed in lines with calcium-containing IV solutions (avoid concurrent use, especially in neonates).
* **Fluoroquinolones/Tetracyclines:** Calcium significantly decreases absorption (oral); intravenous calcium generally poses less binding risk but should be separated.
## Monitoring
* Serum ionized calcium or total calcium (corrected for albumin).
* Continuous ECG monitoring during rapid IV administration.
* Site inspection for signs of extravasation (erythema, swelling).
## Clinical Pearls
* **Potency:** Calcium gluconate is preferred over calcium chloride for peripheral administration because it is less irritating to veins, though extravasation remains a high-risk complication.
* **Precipitation:** Always flush the IV line thoroughly with normal saline between medications to prevent precipitate formation.
* **Correction:** Always correct total calcium for hypoalbuminemia (Corrected Calcium = Serum Ca + 0.8 * [4.0 - Serum Albumin]).
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**Disclaimer:** This information is for educational purposes only. Clinical protocols must be verified against current institutional guidelines and official prescribing information (package inserts) before administration. Clinical judgment should be exercised based on individual patient status.
