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# Calcium Gluconate
## Overview
Calcium gluconate is a parenteral calcium salt used to restore or maintain calcium homeostasis. It provides less elemental calcium (approx. 90 mg) per 1 gram of salt compared to calcium chloride (approx. 270 mg), making it less irritating to peripheral veins and preferred for routine supplementation or hypocalcemia without cardiac arrest.
## Primary Indications
* Acute symptomatic hypocalcemia.
* Hyperkalemia-induced cardiac membrane stabilization (adjunct).
* Magnesium toxicity reversal.
* Calcium channel blocker (CCB) or hydrofluoric acid toxicity.
## Adult Dosing
* **Hypocalcemia:** 1–2 grams IV (10–20 mL of 10% solution). Administer over 10–20 minutes. May repeat every 4–6 hours as needed based on serum levels.
* **Cardiac Membrane Stabilization (Hyperkalemia):** 1–2 grams IV over 2–5 minutes. May repeat after 5 minutes if ECG changes persist.
* **CCB Toxicity:** 1–3 grams IV bolus, followed by a continuous infusion of 0.5–1.5 mg/kg/hour (local protocol varies widely; consultation with Toxicologist recommended).
## Pediatric Dosing
* **Hypocalcemia:** 50–100 mg/kg/dose (0.5–1 mL/kg of 10% solution) IV slowly over 10–20 minutes.
* **Cardiac Emergency:** 50–100 mg/kg/dose IV push slowly.
* *Note: Ensure calcium concentration and infusion rates are verified by pediatric-specific reference charts (e.g., Harriet Lane) due to risk of tissue necrosis.*
## Dose Adjustments
* **Renal Impairment:** No specific adjustment necessary, but monitor serum calcium levels closely to prevent hypercalcemia.
* **Hepatic Impairment:** No specific adjustment required.
## Contraindications
* Ventricular fibrillation (unless treating hyperkalemia).
* Hypercalcemia.
* Digitalis toxicity (increased risk of severe arrhythmias).
## Adverse Effects
* **Common:** Peripheral vasodilation, hypotension, bradycardia (if infused too rapidly), local site irritation.
* **Serious:** Tissue necrosis (if extravasation occurs), cardiac arrest (with rapid bolus), ectopic calcification.
## Key Drug Interactions
* **Digoxin:** Calcium sensitizes the heart to digitalis; may precipitate severe arrhythmias. Avoid in digitalis toxicity.
* **Ceftriaxone:** Physical incompatibility. Intravenous mixtures can form calcium-ceftriaxone precipitates, which may be fatal in neonates. Do not administer via the same line within 48 hours.
* **Tetracyclines/Fluoroquinolones:** Calcium can chelate these drugs, reducing their absorption/efficacy.
## Monitoring
* **Laboratory:** Serum ionized calcium (preferred) or total calcium, magnesium, potassium, and phosphorus.
* **Clinical:** Continuous ECG monitoring during IV bolus (watch for bradycardia).
* **Site:** Assess for signs of extravasation frequently, as calcium gluconate is a vesicant.
## Clinical Pearls
* **Extravasation Management:** If extravasation occurs, stop the infusion immediately. Elevate the limb and monitor for tissue damage; consider hyaluronidase infiltration if significant infiltration occurs.
* **Compatibility:** Calcium is incompatible with many drugs (e.g., sodium bicarbonate, phosphates). Always flush the IV line thoroughly before and after administration.
* **Administration:** When possible, administer via a central line to minimize risk of phlebitis or tissue damage, especially for higher concentrations or continuous infusions.
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**Educational Disclaimer:** This information is for educational purposes only. Clinical practice and local protocols vary. Always verify specific dosing, safety, and compatibility information using current institutional guidelines, the most recent package insert, and reputable clinical references (e.g., Lexicomp, Micromedex) before prescribing or administering medication.
