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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to restore serum calcium levels and manage hyperkalemia-induced cardiotoxicity. Compared to calcium chloride, it is less tissue-irritating if extravasation occurs, though it contains less elemental calcium (1 g calcium gluconate ≈ 90 mg elemental calcium).
## Primary Indications
* Hypocalcemia
* Hyperkalemia (cardioprotection)
* Calcium channel blocker overdose
* Hypermagnesemia (symptomatic)
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infusion over 1–2 hours. May repeat based on serum ionized calcium levels.
* **Hyperkalemia/Cardioprotection:** 1–2 g IV push (usually over 5–10 minutes). May repeat every 5 minutes if ECG changes persist.
* **Maximum rate:** 200 mg/minute (to prevent hypotension, bradycardia, or arrhythmias).
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose IV over 10–20 minutes. May repeat as needed.
* **Hyperkalemia:** 50–100 mg/kg/dose (max 1–2 g) IV push over 5–10 minutes.
* *Note: Always verify exact dosing via local institutional protocols (e.g., PALS/pediatric ICU guidelines).*
## Dose Adjustments
* **Renal Impairment:** No specific adjustment, but use with caution to avoid hypercalcemia if impaired clearance exists.
* **Hepatic Impairment:** No specific adjustment.
## Contraindications
* Ventricular fibrillation (during resuscitation).
* Hypercalcemia.
* Digitalis toxicity (increased risk of severe arrhythmias).
## Adverse Effects
* **Injection site:** Extravasation can cause severe tissue necrosis and sloughing (treat with hyaluronidase if it occurs).
* **Systemic:** Hypotension, bradycardia, arrhythmias (if infused too rapidly), vasodilation, and metallic taste.
## Key Drug Interactions
* **Ceftriaxone:** Physical incompatibility. Do not co-administer or use in the same IV line (forms insoluble precipitate). Verify line flushing compatibility if secondary lines are used.
* **Digoxin:** Calcium increases the risk of digitalis toxicity; monitor closely for arrhythmias.
* **Tetracyclines/Fluoroquinolones:** Calcium can chelate and reduce absorption if administered orally or via concurrent complexation (rare in IV context).
## Monitoring
* **Labs:** Serum ionized calcium (preferred over total calcium), magnesium, and phosphate levels.
* **Cardiac:** Continuous ECG monitoring during rapid IV administration.
* **Local:** Assess IV site frequently for signs of infiltration or extravasation.
## Clinical Pearls
* **Calcium Concentration:** 1 g calcium gluconate contains approximately 4.6 mEq of elemental calcium.
* **Administration:** Ensure the IV is patent and blood return is confirmed prior to injection to mitigate risk of severe extravasation injury.
* **Compatibility:** Highly incompatible with many drugs (e.g., carbonates, sulfates, phosphates). Always flush the line thoroughly (e.g., 0.9% NaCl) before and after administration.
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*Disclaimer: This information is for educational purposes only. Dosing and clinical practices should be verified against institutional guidelines, current hospital protocols, and the most recent package inserts before prescribing or administering medication.*
