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# Calcium Gluconate
## Overview
Calcium gluconate is an intravenous (or oral) calcium salt used to restore serum calcium levels and treat cardiotoxicity associated with hyperkalemia. It contains approximately 90 mg of elemental calcium per 1 gram of calcium gluconate. It is preferred over calcium chloride for peripheral administration due to lower risk of tissue extravasation injury.
## Primary Indications
* Hypocalcemia (acute/symptomatic).
* Hyperkalemia-associated cardiac membrane stabilization.
* Calcium channel blocker or magnesium toxicity antidote.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams IV administered slowly (no faster than 200 mg/min). May repeat every 4–6 hours based on serum levels.
* **Hyperkalemia (Cardioprotection):** 1–2 grams IV (10 mL of 10% solution). May repeat after 5 minutes if ECG changes persist.
* **Administration:** Diluted in D5W or NS is often recommended for pediatric/complex patients, though 10% solution can be given directly via large central vein or slow peripheral push.
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg/dose (max 1–2 grams) IV slowly.
* **Hyperkalemia:** 50–100 mg/kg/dose IV over 5–10 minutes.
* **Note:** Dosing varies significantly by institutional protocol; verify local neonatal/pediatric formulas for concentration-specific administration.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium levels closely as accumulation can occur.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Ventricular fibrillation (during cardiac resuscitation).
* Hypercalcemia.
* Severe renal impairment (if calcium-phosphorus product is high).
* Digitalis toxicity (relative contraindication; may precipitate severe arrhythmias).
## Adverse Effects
* **Extravasation:** Causes severe tissue necrosis and calcinosis cutis.
* **Rapid infusion:** Bradycardia, hypotension, cardiac arrhythmias (including asystole), hot flashes, and metallic taste.
* **Gastrointestinal:** Constipation (oral use).
## Key Drug Interactions
* **Digoxin:** Calcium increases the risk of digitalis toxicity; monitor for arrhythmias.
* **Ceftriaxone:** Physical incompatibility; formation of precipitate (contraindicated in neonates).
* **Tetracyclines/Fluoroquinolones:** Decreased absorption if administered orally (separate by 2–4 hours).
## Monitoring
* **Serum Calcium:** Monitor total and ionized calcium levels.
* **ECG:** Continuous cardiac monitoring during IV infusion, particularly in the treatment of hyperkalemia.
* **Infusion Site:** Inspect frequently for signs of infiltration.
## Clinical Pearls
* **Peripheral vs Central:** If possible, administer via central line. If peripheral, choose a large vein; confirm patency frequently.
* **Precipitation:** Incompatible with additives such as phosphates, carbonates, and sulfates. Flush lines thoroughly before and after administration.
* **Conversion:** 1 gram of calcium gluconate provides ~4.65 mEq of elemental calcium.
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*Disclaimer: This information is for educational purposes only. Clinical practice protocols and concentrations vary by facility. Always verify dosing and compatibility using institutional resources or the most current prescribing information before administration.*
