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# Calcium Gluconate
## Overview
Calcium gluconate is a calcium salt used primarily to treat hypocalcemia and as an adjunct in hyperkalemia. Compared to calcium chloride, it is less tissue-irritating, making it suitable for peripheral administration, though extravasation remains a risk.
## Primary Indications
* Acute symptomatic hypocalcemia.
* Cardiac membrane stabilization in severe hyperkalemia (does not lower potassium).
* Calcium channel blocker overdose or magnesium toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infused over 10–20 minutes. May repeat q4–6h as needed based on serum calcium.
* **Hyperkalemia / Stabilizing Cardiac Membranes:** 1–2 g IV push over 5–10 minutes. May repeat if ECG changes persist.
* **Note:** Dosing is often facility-specific. Verify local guidelines for infusion rates.
## Pediatric Dosing
* **Hypocalcemia:** 100–200 mg/kg (equivalent to 1–2 mL/kg of 10% solution) IV slow push over 10–20 minutes.
* **Hyperkalemia / Emergency:** 50–100 mg/kg IV slow push over 5–10 minutes.
* **Maximum Dose:** Should not exceed the adult dose.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium levels frequently as patients may be at higher risk for hypercalcemia.
* **Hepatic Impairment:** No standard dosage adjustment required.
## Contraindications
* Ventricular fibrillation.
* Hypercalcemia.
* Digoxin toxicity (unless life-threatening hypocalcemia is present, as it may precipitate fatal arrhythmias).
## Adverse Effects
* **Common:** Hypotension, bradycardia (if pushed too rapidly), flushing, metallic taste.
* **Serious:** Tissue necrosis/sloughing (if extravasation occurs), cardiac arrhythmias, hypercalcemia.
## Key Drug Interactions
* **Digoxin:** Increases risk of digitalis toxicity/cardiac arrhythmias.
* **Ceftriaxone:** Physical incompatibility. Do not mix or administer simultaneously in the same IV line (precipitation risk).
* **Tetracyclines/Fluoroquinolones:** Calcium can chelate these antibiotics, significantly reducing absorption. Separate doses by at least 2–4 hours.
## Monitoring
* **Serum Calcium:** Monitor total and ionized calcium levels.
* **ECG:** Continuous monitoring is recommended during rapid IV administration.
* **Site Assessment:** Essential to monitor for signs of extravasation (pain, swelling, blanching).
## Clinical Pearls
* **Compatibility:** Calcium gluconate is incompatible with phosphates, carbonates, and sulfates; do not mix in the same solution.
* **Extravasation:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor; local protocols may suggest sodium thiosulfate injections.
* **Preparation:** 1 gram of calcium gluconate provides approximately 90 mg (4.6 mEq) of elemental calcium.
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**Disclaimer:** This information is for educational purposes only. Always verify dosages, contraindications, and compatibility with your institution's current prescribing information, formulary, and clinical protocols before administration.
