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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt used to treat and prevent hypocalcemia. It is available in oral and intravenous formulations.
## Primary Indications
* Treatment of hypocalcemia
* Management of cardiac arrest with hyperkalemia or hypomagnesemia
* Treatment of acute fluoride poisoning
* Management of Black Widow spider bites
## Adult Dosing
* **Hypocalcemia:**
* **Oral:** 1 to 2 grams elemental calcium (equivalent to approximately 980 mg to 1.96 grams of calcium gluconate) 2-4 times daily.
* **Intravenous:** 10 mL of 10% calcium gluconate solution (approximately 90 mg elemental calcium or 4.5 mEq) administered slowly over 5-10 minutes. May be repeated every 4-6 hours as needed. For severe symptomatic hypocalcemia, continuous infusion may be considered, with dosing guided by serum calcium levels.
* **Cardiac Arrest with hyperkalemia or hypomagnesemia:** 10 mL of 10% calcium gluconate solution (approximately 90 mg elemental calcium or 4.5 mEq) IV push.
* **Fluoride Poisoning:** Oral or gastric lavage with 10% calcium gluconate solution. IV may be used if absorption is a concern.
* **Black Widow Spider Bites:** 10 mL of 10% calcium gluconate solution IV.
Dosing for hypocalcemia and other indications may vary based on electrolyte levels and clinical presentation; specific protocols should be followed.
## Pediatric Dosing
* **Hypocalcemia:**
* **Oral:** 45-65 mg elemental calcium per kg per dose (equivalent to approximately 450-650 mg calcium gluconate per kg per dose) divided into 1-5 doses daily. Maximum daily dose not well established.
* **Intravenous (symptomatic):** 100-200 mg elemental calcium per kg (equivalent to 1 mL to 2 mL of 10% calcium gluconate solution per kg) diluted to 5-10% and infused over 10-20 minutes. Maximum dose: 1 gram elemental calcium (10.9 mL of 10% calcium gluconate solution). May be followed by continuous infusion if needed.
* **Neonatal Hypocalcemia:** 100 mg elemental calcium per kg per day (equivalent to 1 mL/kg of 10% solution) in divided doses.
Exact pediatric dosing should be guided by institutional protocols and serum calcium levels.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment for acute administration. However, chronic oral use in severe renal impairment warrants caution due to potential hypercalcemia and accumulation.
## Contraindications
* Hypercalcemia
* History of kidney stones (nephrolithiasis)
* Ventricular fibrillation (for IV administration, can exacerbate arrhythmias)
* Known hypersensitivity to calcium gluconate
## Adverse Effects
* **Common:** Constipation (oral), nausea, vomiting.
* **Less Common/Serious:** Hypotension, bradycardia, arrhythmias (especially with rapid IV infusion), hypercalcemia, tissue calcification/necrosis (with extravasation), warmth or tingling sensation.
## Key Drug Interactions
* **Thiazide Diuretics:** Increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia increases the risk of digoxin toxicity.
* **Tetracyclines and Fluoroquinolones:** Calcium can chelate with these antibiotics, reducing their absorption. Administer at least 2 hours before or 4-6 hours after calcium.
* **Bisphosphonates and Sodium Fluoride:** Calcium can reduce the absorption of these agents. Separate administration by at least 2 hours.
* **Administer IV calcium products
