Please check your internet connection and try again.
# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt providing calcium, an essential mineral for various physiological processes including bone health, nerve transmission, and muscle contraction.
## Primary Indications
* Treatment of hypocalcemia.
* Antidote for toxic ingestions of magnesium sulfate and hydrofluoric acid.
* Adjunct in the management of hyperkalemia (to stabilize cardiac membranes).
## Adult Dosing
* **Hypocalcemia:** Intravenous (IV) administration is typically 10 mL of 10% calcium gluconate (90 mg elemental calcium, 4.5 mEq) given slowly over 10-20 minutes. Repeat doses may be given every 1-2 hours based on serum calcium levels and clinical response. Maximum daily dose is not well-established and depends on clinical need and monitoring.
* **Magnesium Sulfate Overdose:** IV 10 mL of 10% calcium gluconate (90 mg elemental calcium, 4.5 mEq) given slowly over 10-20 minutes. Repeat every 5-15 minutes as needed, guided by clinical signs and serum magnesium levels.
* **Hydrofluoric Acid Exposure (Topical):** Topical gel or submersion in 2.5% calcium gluconate solution is recommended. Specific concentrations and durations depend on the severity of exposure and local protocols.
* **Hyperkalemia:** IV 10 mL of 10% calcium gluconate (90 mg elemental calcium, 4.5 mEq) given slowly over 5-10 minutes. This dose does not significantly lower potassium but stabilizes the cardiac membrane.
## Pediatric Dosing
* **Hypocalcemia:** IV administration is typically 0.5-1 mL/kg of 10% calcium gluconate (45-90 mg elemental calcium per kg, 2.25-4.5 mEq/kg) given slowly over 10-20 minutes. Repeat doses may be given every 4-6 hours based on serum calcium levels and clinical response. Local protocols often guide maximal doses and infusion rates.
* **Magnesium Sulfate Overdose:** IV 0.2 mL/kg of 10% calcium gluconate (18 mg elemental calcium per kg, 0.9 mEq/kg) given slowly over 5-10 minutes. Repeat every 5-15 minutes as needed, guided by clinical signs and serum magnesium levels.
## Dose Adjustments
No specific dose adjustments are typically required for hepatic or renal impairment, though careful monitoring of serum calcium and electrolytes is essential in patients with kidney disease.
## Contraindications
* Hypercalcemia.
* Ventricular fibrillation.
* Renal calculi (relative contraindication for oral calcium).
* History of specific allergies to calcium gluconate.
## Adverse Effects
Common: Hypotension, bradycardia, peripheral vasodilation, nausea, vomiting, constipation (oral), local irritation/extravasation pain or tissue necrosis (IV).
Rare: Cardiac arrhythmias, hypercalcemia, calcification of soft tissues.
## Key Drug Interactions
* **Digoxin:** Increased risk of digoxin toxicity if hypercalcemia occurs.
* **Tetracyclines and Fluoroquinolones:** Calcium can chelate these antibiotics, reducing their absorption. Separate administration by at least 2-4 hours.
* **Thiazide Diuretics:** May increase serum calcium levels.
* **Bisphosphonates and Sodium Fluoride:** Calcium can reduce the absorption and efficacy of these medications.
## Monitoring
* Serum calcium levels (total and ionized).
* Electrolytes (potassium, magnesium, phosphate).
* Electrocardiogram (ECG) for signs of hypercalcemia or hypocalcemia.
* Renal function.
* Signs of extravasation for IV administration.
## Clinical Pearls
* IV calcium gluconate is less irritating than calcium chloride and is preferred for peripheral IV administration.
* Administer IV calcium solution slowly to avoid hypotension and cardiac arrhythmias.
* Ensure good IV access and cardiac monitoring during rapid IV administration.
* When infusing with other IV fluids, avoid mixing with sodium bicarbonate or phosphate-containing solutions due to precipitation risk.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and relevant clinical guidelines before making treatment decisions.*
