Calcium%252525252525252525252525252520gliconate

# Calcium Gluconate ## Overview Calcium gluconate is a calcium salt used primarily to treat hypocalcemia, manage hyperkalemia-induced cardiac membrane instability, and treat calcium channel blocker or magnesium toxicity. It provides 90 mg of elemental calcium per 1 gram of calcium gluconate. It is preferred over calcium chloride for peripheral administration due to a lower risk of tissue necrosis if extravasation occurs. ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac stabilization in hyperkalemia (ECG changes). * Calcium channel blocker overdose. * Magnesium sulfate 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 (Cardioprotection):** 1–2 g IV push over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Calcium Channel Blocker/Magnesium Toxicity:** 1–4 g IV bolus; infusion may be required (dosing varies locally; consult institutional protocol). ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (max 2 g/dose) IV slow push or infusion. * **Hyperkalemia:** 50–100 mg/kg/dose IV push slowly over 5–10 minutes (max 2 g/dose). * *Note: Dosing should always be weight-based; confirm institutional concentration limits for safety.* ## Dose Adjustments * **Hepatic/Renal Impairment:** No specific adjustment, but use caution in severe renal impairment to prevent hypercalcemia. Monitor serum calcium frequently. ## Contraindications * Hypercalcemia. * Ventricular fibrillation (during resuscitation). * Digitalis toxicity (increased risk of severe arrhythmias). * Hypersensitivity to calcium salts. ## Adverse Effects * **Common:** Hypotension, bradycardia, arrhythmias (if infused too rapidly), tingling sensation, metallic taste, flushing. * **Serious:** Tissue necrosis/sloughing (if extravasation occurs), cardiac arrest (with rapid IV push). ## Key Drug Interactions * **Digoxin:** Increases risk of digitalis toxicity; may precipitate lethal arrhythmias. * **Ceftriaxone:** Physical incompatibility; formation of insoluble ceftriaxone-calcium precipitates in the lungs or kidneys (fatal). **Never use in the same IV line.** * **Tetracyclines/Fluoroquinolones/Levothyroxine:** Calcium chelation decreases the absorption of these oral medications (separate administration by at least 2–4 hours). ## Monitoring * **Cardiac:** Continuous ECG monitoring during administration (watch for bradycardia or arrhythmias). * **Laboratory:** Serum ionized calcium (preferred) or total calcium, magnesium, potassium, and phosphorus. * **Site:** Monitor IV site closely for signs of extravasation (pain, redness, swelling). ## Clinical Pearls * **Administration:** Infuse slowly. Rapid IV administration can precipitate fatal cardiac arrhythmias. * **Extravasation Management:** If extravasation occurs, stop the infusion immediately. If severe, consider sodium thiosulfate (investigational/local protocol). * **Compatibility:** Calcium is highly incompatible with many medications (e.g., sodium bicarbonate, phosphates). Use a dedicated line or flush thoroughly between medications. * **Dosing Confusion:** Always verify if the order is for calcium gluconate vs. calcium chloride. Calcium chloride is much more concentrated (3x the elemental calcium) and is vesicant (must be given via central line). *** **Disclaimer:** This information is for educational purposes only. Always verify drug dosages, contraindications, and compatibility with the most current institutional protocols and standardized prescribing information (e.g., package inserts or clinical drug databases) before administration.