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# Calcium Gluconate
## Overview
Calcium gluconate is a calcium salt used primarily to restore serum calcium levels and manage hyperkalemia-induced cardiotoxicity. It provides less elemental calcium (approx. 93 mg per 1 g of calcium gluconate) compared to calcium chloride but is less irritating to peripheral veins.
## Primary Indications
* Hypocalcemia (acute/symptomatic).
* Adjunct in the management of severe hyperkalemia (to stabilize the cardiac membrane).
* Calcium channel blocker toxicity or magnesium sulfate toxicity (as an antidote).
* Cardiac resuscitation (if hypocalcemia is suspected).
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV slow infusion. Can repeat every 4–6 hours as needed based on serum calcium levels.
* **Hyperkalemia / Cardioprotection:** 1–2 g IV over 5–10 minutes. May repeat if ECG changes persist.
* **Administration Note:** Do not exceed 200 mg/minute of calcium gluconate to prevent bradycardia/arrhythmias.
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose IV over 10–20 minutes. May repeat q6h.
* **Hyperkalemia / Cardiac Arrest:** 60–100 mg/kg/dose IV over 5–10 minutes.
* **Note:** Dosing varies significantly by institutional protocol; verify with site-specific guidelines and Pharmacy/ICU policies.
## Dose Adjustments
* **Renal Impairment:** No specific adjustment; however, monitor closely for hypercalcemia if renal function is severely impaired.
* **Hepatic Impairment:** No dosage adjustment necessary.
## Contraindications
* Ventricular fibrillation; hypercalcemia; digitalis toxicity (increased risk of precipitation of arrhythmias).
## Adverse Effects
* **Rapid/Bolus administration:** Bradycardia, syncope, cardiac arrhythmias, hypotension.
* **Extravasation:** Severe tissue necrosis, sloughing, and calcinosis cutis.
* **Other:** Chalky taste, tingling sensations, flushing, nausea.
## Key Drug Interactions
* **Digitalis Glycosides:** Increased risk of severe digitalis toxicity/arrhythmias; monitor ECG closely.
* **Ceftriaxone:** Physical incompatibility (calcium-ceftriaxone precipitation). Do not co-administer or use in the same IV line, especially in neonates.
* **Tetracyclines/Fluoroquinolones:** Decreased absorption if administered orally; separate doses by at least 2–4 hours.
* **Phosphate-containing solutions:** Potential for calcium-phosphate precipitation.
## Monitoring
* **Serum Electrolytes:** Ionized calcium (preferred) or total calcium, magnesium, and potassium levels.
* **Cardiac:** ECG monitoring during IV administration (watch for bradycardia or shortening of QT interval).
* **Site:** Observe IV site frequently for extravasation.
## Clinical Pearls
* **IV Compatibility:** Calcium gluconate is incompatible with carbonates, phosphates, sulfates, and tartrates. Flush the line thoroughly before and after administration.
* **Preferred Route:** IV is preferred for emergency stabilization. It can be given peripherally if the line is patent, but central access is preferred for large or rapid dosing to avoid tissue damage.
* **Extravasation Management:** If extravasation occurs, stop the infusion immediately and consult institutional policy regarding the use of sodium thiosulfate or hyaluronidase.
* **Elemental Calcium:** 1 g of calcium gluconate contains approximately 4.65 mEq of elemental calcium.
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**Educational Disclaimer:** This information is for educational purposes only. Always verify doses, contraindications, and drug compatibility with current institutional protocols, primary literature, or a board-certified clinical pharmacist before prescribing or administering.
