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# Calcium Gluconate ## Overview Calcium gluconate is a parenteral calcium salt used primarily for the urgent management of hypocalcemia and hyperkalemia-induced cardiotoxicity. It provides 90 mg (4.65 mEq) of elemental calcium per 1 gram of calcium gluconate. It is less tissue-irritating than calcium chloride and is preferred for peripheral administration. ## Primary Indications * Severe symptomatic hypocalcemia. * Cardiac membrane stabilization in hyperkalemia. * Magnesium toxicity (antidote). * Calcium channel blocker overdose (adjunctive). ## Adult Dosing * **Hypocalcemia:** 1–2 grams IV infused over 10–20 minutes. May repeat every 4–6 hours as needed based on serum ionized calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 grams IV administered over 5–10 minutes. Can be repeated after 5 minutes if ECG changes persist. * **Continuous Infusion:** 0.5–2 mg/kg/hour for refractory hypocalcemia. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (max 2 g) IV infused over 10–20 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose IV over 5–10 minutes. * **Note:** Always verify specific hospital or neonatal guidelines for premature infants, as dosing is highly standardized by institutional weight-based protocols. ## Dose Adjustments * **Renal Impairment:** No specific adjustment, but monitor levels closely due to risk of metastatic calcification if hyperphosphatemia is present. * **Hepatic Impairment:** No adjustment required. ## Contraindications * Ventricular fibrillation (during resuscitation). * Digitalis toxicity (increased risk of severe arrhythmias). * Hypercalcemia. * Hypercalciuria. ## Adverse Effects * **Common:** Peripheral vasodilation (flushing, tingling), hypotension, bradycardia (if infused too rapidly). * **Serious:** Tissue necrosis upon extravasation (calcium is a vesicant), cardiac arrest. * **Local:** Injection site pain. ## Key Drug Interactions * **Digitalis Glycosides:** Concurrent use increases risk of fatal arrhythmias. * **Ceftriaxone:** Fatal precipitation in neonates; never mix in the same IV line or administer concurrently. * **Phosphate-containing solutions:** Physically incompatible; causes precipitation. ## Monitoring * **Serum Calcium:** Monitor total and ionized calcium frequently. * **ECG:** Mandatory during IV administration to monitor for bradycardia or arrhythmias. * **Site Assessment:** Monitor IV site meticulously to ensure patency; extravasation requires immediate intervention (e.g., stopping infusion, monitoring for tissue damage). ## Clinical Pearls * **Peripheral vs. Central:** Calcium gluconate can be given peripherally if necessary, but central venous access is preferred for continuous infusions or high concentrations to avoid extravasation injury. * **Extravasation Management:** If extravasation occurs, stop the infusion immediately and consider local infiltration with sodium thiosulfate if severe. * **Normalization:** Always correct total calcium for serum albumin level: *Corrected Ca = Measured Ca + 0.8 * (4.0 - Albumin).* * **Protocol Dependency:** Always refer to local institutional protocols, especially regarding infusion rates and pediatric weight-based calculations. *** **Disclaimer:** This information is for educational purposes only. Clinical dosing and indications may change. Always verify current prescribing information and local institutional clinical practice guidelines before administration.