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# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt of calcium used to treat or prevent calcium deficiencies. It is available in oral and intravenous formulations. ## Primary Indications * Hypocalcemia (treatment and prevention) * Adjunctive treatment in magnesium sulfate overdose * Adjunctive treatment in acute hyperkalemia (to stabilize cardiac membrane) * Toxicity from calcium channel blockers * Magnesium sulfate overdose ## Adult Dosing * **Hypocalcemia (IV):** 10 mL of 10% calcium gluconate solution (equivalent to 90 mg elemental calcium, 4.5 mEq) administered slowly over 5-10 minutes. May be repeated every 10-20 minutes as needed, not to exceed 1 to 2 g (10 to 22 mL) in 24 hours. * **Hypocalcemia (Oral):** 1 to 2 g (1000 mg to 2000 mg) elemental calcium (equivalent to 10 to 20 mL of 10% oral solution, or tablets equivalent to 1-2g elemental calcium) taken 3-4 times daily. * **Magnesium Sulfate Overdose (IV):** 10 mL of 10% calcium gluconate solution administered over 5-10 minutes. * **Hyperkalemia (IV):** 5-10 mL of 10% calcium gluconate solution administered over 5-10 minutes. Repeat as needed, but therapy is usually short-lived as it does not lower potassium levels. * **Calcium Channel Blocker Toxicity (IV):** 10 mL of 10% calcium gluconate solution administered over 5-10 minutes. May be repeated every 5-10 minutes. Higher doses may be required. *Note: Dosing may vary based on the severity of hypocalcemia and response. Consult local protocols.* ## Pediatric Dosing * **Hypocalcemia (IV):** 0.5 to 1 mL/kg of 10% calcium gluconate solution (equivalent to 45 to 90 mg elemental calcium per kg) administered slowly over 5-10 minutes. May be repeated every 10-20 minutes as needed. Maximum dose 2 g per day. * **Hypocalcemia (Oral):** Dosing varies based on age and severity of deficiency. Consult pediatric guidelines. ## Dose Adjustments No dose adjustment necessary for renal or hepatic impairment, though caution is advised in severe renal impairment. ## Contraindications * Hypercalcemia * Ventricular fibrillation * History of kidney stones (renal calculi) * Certain cardiac conditions (e.g., digoxin toxicity, severe renal failure) ## Adverse Effects * **IV:** Hypotension, bradycardia, cardiac arrhythmias, phlebitis, extravasation leading to tissue necrosis. * **Oral:** Constipation, gas, nausea, vomiting, abdominal pain. * **General:** Hypercalcemia symptoms (e.g., thirst, frequent urination, nausea, vomiting, abdominal pain, constipation, bone pain, confusion, fatigue). ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Oral calcium can significantly reduce the absorption of these antibiotics. Administer oral calcium at least 2 hours before or 4-6 hours after these antibiotics. * **Bisphosphonates:** Oral calcium can decrease the absorption and efficacy of bisphosphonates. Administer oral calcium at least 2 hours before or 6-8 hours after bisphosphonates. * **Digoxin:** IV calcium can potentiate digoxin toxicity, especially in patients with hypercalcemia. * **Thiazide Diuretics:** May increase serum calcium levels. ## Monitoring * Serum calcium levels (prior to and during treatment) * Cardiac rhythm (especially with IV administration) * Signs and symptoms of hypocalcemia or hypercalcemia * Renal function ## Clinical Pearls * When administering IV calcium gluconate, it should be given slowly and preferably through a central venous line to minimize the risk of phlebitis and extravasation. * Never mix IV calcium gluconate with bicarbonate or phosphate solutions due to the potential for precipitation. * Oral calcium absorption is best when taken with food. * Intravenous calcium gluconate is less irritating to veins than calcium chloride but contains less elemental calcium per unit volume. --- **Disclaimer:** This information is intended for clinical pharmacist use and does not replace a thorough review of the most current prescribing information, drug monographs, or consultation with a physician. Always verify the latest product information and patient-specific factors before making any clinical decisions.