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# Calcium Gluconate
## Overview
Calcium gluconate is a calcium salt used primarily to manage hypocalcemia and cardiac membrane stabilization in hyperkalemia. It provides lower elemental calcium content compared to calcium chloride (approx. 90 mg elemental calcium per 1 g of calcium gluconate).
## Primary Indications
* Acute symptomatic hypocalcemia.
* Cardiac membrane stabilization in severe hyperkalemia (does not lower potassium levels).
* Magnesium toxicity (antidote).
* Calcium channel blocker overdose (off-label).
## Adult Dosing
* **Hypocalcemia:** 1–2 g IV infusion over 10–20 minutes; may repeat as needed based on serum calcium levels. Maintenance infusion: 0.5–2 mg/kg/hour.
* **Hyperkalemia/Magnesium Toxicity:** 1–2 g IV (undiluted or diluted) administered over 5–10 minutes. May repeat after 5 minutes if ECG changes persist.
* **Maximum Infusion Rate:** Should generally not exceed 200 mg/minute to avoid bradycardia or arrhythmias.
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg IV per dose. Administer slowly over 10–20 minutes.
* **Emergency (Cardiac protection/Toxicity):** 50–100 mg/kg IV (Max 2 g). Administer over 5–10 minutes. Monitor for bradycardia.
## Dose Adjustments
* **Renal Impairment:** Use with caution; monitor serum calcium levels closely.
* **Hepatic Impairment:** No specific dosage adjustments established.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation or hypercauliemic states (Digoxin toxicity is a relative contraindication; use calcium with extreme caution if the patient is on digoxin, as it may precipitate arrhythmia).
## Adverse Effects
* **Local:** Extravasation can lead to tissue necrosis, sloughing, and calcinosis cutis.
* **Systemic:** Bradycardia, arrhythmias, hypotension (with rapid infusion), metallic taste, tingling, and syncope.
## Key Drug Interactions
* **Digoxin:** Increases risk of severe cardiac arrhythmias.
* **Ceftriaxone:** Physical incompatibility (precipitate formation) in IV lines. Flush lines thoroughly between administrations or use separate lines.
* **Tetracylines/Fluoroquinolones:** Decreased absorption/efficacy if given concurrently (oral).
## Monitoring
* **Cardiac:** Continuous ECG/telemetry during IV bolus administration.
* **Laboratory:** Serum ionized calcium levels, total calcium, and albumin.
* **Vitals:** Blood pressure and heart rate during infusion.
* **Site:** Check IV patency frequently to prevent extravasation.
## Clinical Pearls
* **Extravasation Management:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor; consult plastic surgery if tissue damage is suspected.
* **Calcium Gluconate vs. Chloride:** Calcium gluconate is preferred for peripheral administration due to a lower risk of tissue necrosis compared to calcium chloride. Always verify which salt is ordered.
* **Dosing Variability:** Many hospitals have specific standardized order sets or protocols for calcium replacement. Always refer to your institutional pharmacy policy.
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*Disclaimer: This information is for educational purposes only. Clinical practice varies by institution; always verify current prescribing information, institutional protocols, and patient-specific factors before administration.*
