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# Calcium Gluconate ## Overview Calcium gluconate is a mineral supplement used to treat or prevent low blood calcium levels. Calcium is essential for normal nerve and muscle function, and for bone health. ## Primary Indications * Hypocalcemia (low blood calcium) * Adjunctive treatment of hyperkalemia (high blood potassium) to stabilize cardiac membranes * Magnesium sulfate toxicity ## Adult Dosing * **Hypocalcemia:** Typically administered intravenously (IV). See specific indication, often calculated based on serum calcium levels. A common initial dose for acute symptomatic hypocalcemia is 10-20 mL of a 10% solution (100-200 mg elemental calcium) IV over 10-20 minutes. Further doses may be given to maintain serum calcium. Higher doses may be warranted in specific situations (e.g., severe hypocalcemia, cardiac arrest). * **Adjunctive treatment for hyperkalemia:** 10 mL of 10% calcium gluconate IV over 5-10 minutes. Repeat doses may be given every 5-10 minutes as needed to stabilize the ECG, not to lower potassium levels. * **Magnesium sulfate toxicity:** 10 mL of 10% calcium gluconate IV over 5-10 minutes. Repeat doses may be given every 5-10 minutes as needed. Oral calcium gluconate is available but absorption is less predictable and it is less commonly used for acute indications. ## Pediatric Dosing * **Hypocalcemia:** Dosing is weight-based and dependent on serum calcium levels. For IV administration in neonates and children: * General pediatric hypocalcemia: 0.5-1 mL/kg of 10% calcium gluconate (50-100 mg elemental calcium) IV over 10-20 minutes. * Neonatal hypocalcemia: 1-1.5 mL/kg of 10% calcium gluconate (100-150 mg elemental calcium) IV over 5-10 minutes per some protocols. * Maximum infusion rate for neonates is typically 1 mL/kg/hr (100 mg/kg/hr). * Further doses are guided by serum calcium levels. * **Adjunctive treatment for hyperkalemia:** 0.1-0.2 mL/kg of 10% calcium gluconate IV, infused slowly. * **Magnesium sulfate toxicity:** 0.2 mL/kg of 10% calcium gluconate IV over 5-10 minutes. Exact dosing should follow institutional guidelines or physician orders. ## Dose Adjustments No specific dose adjustments are routinely required for hepatic or renal impairment, however, the underlying cause of hypocalcemia or hyperkalemia may require specific management. ## Contraindications * Hypercalcemia * Ventricular fibrillation (unless due to hyperkalemia) * History of kidney stones (relative contraindication for chronic oral use) * Certain cardiac conditions (e.g., concomitant use of digoxin) ## Adverse Effects * **Common:** Hypotension, bradycardia, arrhythmias (especially with rapid IV infusion). * **Infusion site reactions:** Extravasation can cause tissue necrosis. * **Other:** Flushing, nausea, vomiting, constipation (oral), chalky taste. * **Hypercalcemia:** Can occur with excessive dosing. ## Key Drug Interactions * **Digoxin:** Increased risk of digoxin toxicity and arrhythmias if hypercalcemia develops. * **Tetracyclines and Fluoroquinolones:** Calcium can chelate these antibiotics, decreasing their absorption. Administer at least 2 hours before or 4-6 hours after. * **Bisphosphonates:** Decreased efficacy of bisphosphonates. * **Thiazide diuretics:** Can increase serum calcium levels. * **Cardiac glycosides:** Increased risk of cardiac arrhythmias. ## Monitoring * Serum calcium levels (frequently after IV administration) * ECG (especially when used for hyperkalemia or in patients with cardiac issues) * Serum magnesium and phosphate levels * Signs of extravasation if IV infused ## Clinical Pearls * Always use an IV infusion pump for IV administration, especially in pediatrics, to control the infusion rate and prevent rapid injection, which can cause hypotension, arrhythmias, and tissue damage. * Never inject calcium gluconate intramuscularly or subcutaneously due to tissue irritation and potential for necrosis. * When infusing IV, ensure a patent IV line and avoid extravasation; use a central line if large or prolonged infusions are required. * Calcium gluconate is preferred over calcium chloride for IV administration in most non-emergency situations due to lower risk of tissue damage upon extravasation and less risk of rapid hypercalcemia. Calcium chloride has a higher elemental calcium content per gram and may be preferred in emergency settings or cardiac arrest. * Monitor for signs and symptoms of hypercalcemia if repeated or high doses are administered. *** **Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information/package insert and institutional guidelines before administering any medication. Clinical decisions should be based on individual patient assessment and current medical evidence.