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# Calcium Gluconate ## Overview Calcium gluconate is a calcium supplement used primarily for the treatment of hypocalcemia or as a cardioprotective agent in hyperkalemia. It provides 93 mg of elemental calcium per 1 gram of calcium gluconate salt (approximately 0.45 mEq/mL). ## Primary Indications * Acute symptomatic hypocalcemia. * Cardiac membrane stabilization in severe hyperkalemia. * Adjunct in cardiac resuscitation (only if hyperkalemia, hypocalcemia, or calcium channel blocker toxicity is suspected). * Magnesium toxicity (antidote). ## Adult Dosing * **Hypocalcemia:** 1–2 grams (IV) administered at a rate of 0.5–2 mL/min. May repeat as needed based on serum calcium levels. * **Hyperkalemia (Cardioprotection):** 1–2 grams (IV) administered over 5–10 minutes. May repeat after 5 minutes if ECG changes persist. * **Dosing Note:** Dosing is highly sensitive to local institutional protocols and the severity of clinical manifestations. ## Pediatric Dosing * **Hypocalcemia:** 100–200 mg/kg/dose (max 2 grams/dose) IV infusion over 5–10 minutes. * **Hyperkalemia:** 50–100 mg/kg/dose (max 2 grams/dose) IV infusion over 5–10 minutes. * **Caution:** Monitor pediatric patients closely for bradycardia and tissue necrosis during administration. ## Dose Adjustments * **Renal Impairment:** No specific adjustment required for acute administration, but use with caution in patients with underlying hyperphosphatemia to avoid metastatic calcification. * **Hepatic Impairment:** No dosage adjustment necessary. ## Contraindications * Ventricular fibrillation (during CPR). * Hypercalcemia. * Severe hypercalciuria. * Digitalis toxicity (increased risk of arrhythmias). ## Adverse Effects * **Cardiovascular:** Bradycardia, arrhythmias, hypotension (with rapid infusion). * **Local:** Venous irritation, burning, and tissue necrosis if extravasation occurs. * **Gastrointestinal:** Chalky taste, nausea/vomiting (with rapid infusion). * **Neurological:** Syncope. ## Key Drug Interactions * **Digoxin:** Calcium can precipitate severe, potentially fatal arrhythmias. Avoid or use extreme caution. * **Ceftriaxone:** Potential for fatal precipitation in neonates (do not co-administer or use in the same IV line/site). * **Tetracyclines/Fluoroquinolones:** Calcium reduces absorption (if given orally) or complexation (if given IV). ## Monitoring * **Serum Calcium:** Monitor total and ionized calcium levels periodically. * **Cardiac:** Continuous ECG monitoring during IV administration, especially when treating hyperkalemia or arrhythmias. * **Site:** Inspect IV site frequently for signs of extravasation or infiltration. ## Clinical Pearls * **Extravasation Risk:** Calcium gluconate is a vesicant. If extravasation occurs, stop infusion immediately, elevate the limb, and consider hyaluronidase injections. * **Stability:** Do not mix with phosphate-containing solutions or carbonates to prevent precipitation of calcium salts. * **Administration:** Calcium gluconate is preferred over calcium chloride for peripheral administration because it is less likely to cause tissue necrosis; however, central line administration remains preferred for high-dose or repeated therapy. * **Hyperkalemia caveat:** Calcium gluconate does not lower serum potassium levels; it only stabilizes the myocardial membrane. Concurrent potassium-lowering therapy must be initiated. *** *Disclaimer: This information is for educational purposes only. Clinical protocols may vary by institution. Always verify dosages and compatibility against current prescribing information or your hospital’s pharmacy department before administration.*