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# Calcium Gluconate ## Overview Calcium gluconate is an inorganic salt used to treat or prevent calcium deficiency. It is available in oral and intravenous formulations. ## Primary Indications * Hypocalcemia (serum calcium < 8.5 mg/dL) * Calcium supplementation * Adjunctive treatment for hyperkalemia (intravenous) * Management of hydrofluoric acid burns (topical) ## Adult Dosing **Hypocalcemia (IV):** * 10-15 mL of 10% solution (90-135 mg elemental calcium) infused slowly over 10-20 minutes. * May be repeated every 6 hours as needed, or administered as a continuous infusion (e.g., 1-2 g elemental calcium per hour) based on clinical response and serum calcium levels. * Maximum infusion rate is typically 1 g elemental calcium per hour (approximately 90 mL of 10% solution) to avoid hypotension and arrhythmias. **Hypocalcemia (Oral):** * Elemental calcium: 1-2 g daily, divided into 2-4 doses. * Calcium gluconate contains approximately 9% elemental calcium by weight. For example, 1000 mg of calcium gluconate provides about 90 mg of elemental calcium. **Calcium Supplementation (Oral):** * Elemental calcium: 1-2 g daily, divided into 2-4 doses. **Hyperkalemia (IV):** * 10 mL of 10% solution (90 mg elemental calcium) infused over 10 minutes as a cardiac membrane stabilizer. Not a treatment for reducing potassium levels. **Hydrofluoric Acid Burns (Topical):** * See specific institutional protocols for topical gel or solution application. ## Pediatric Dosing **Hypocalcemia (IV):** * Neonates: 0.5-1 mL/kg/dose of 10% solution (45-90 mg elemental calcium/kg/dose) infused over 5-10 minutes. * Infants and Children: 1-2 mL/kg/dose of 10% solution (90-180 mg elemental calcium/kg/dose) infused over 10-20 minutes. * Dosing may be repeated every 6 hours as needed. For severe or symptomatic hypocalcemia, a continuous infusion may be considered (e.g., 0.5-1 g elemental calcium/kg/day). **Hypocalcemia (Oral):** * Elemental calcium: 45-85 mg/kg/day, divided into 3-4 doses. **Calcium Supplementation (Oral):** * Infants: 50-100 mg elemental calcium/kg/day, divided into doses. * Children: 500-1000 mg elemental calcium/day, divided into doses. ## Dose Adjustments * No specific dose adjustments for renal or hepatic impairment are typically required for acute IV administration. However, prolonged oral supplementation in severe renal impairment requires careful monitoring. ## Contraindications * Hypercalcemia * Ventricular fibrillation (IV) * Caution in patients with sarcoidosis or those receiving digoxin. ## Adverse Effects * **Most Common (IV):** Extravasation with tissue necrosis (if IV line infiltrates), hypotension, bradycardia, arrhythmias, flushing, nausea, vomiting. * **Common (Oral):** Constipation, abdominal discomfort, flatulence, nausea. * **Rare:** Hypercalcemia, hypercalciuria, kidney stones. ## Key Drug Interactions * **Tetracyclines and Fluoroquinolones:** Calcium gluconate can chelate these antibiotics, reducing their absorption. Separate administration by at least 2-4 hours. * **Bisphosphonates:** Calcium can interfere with the absorption of bisphosphonates. Separate administration by at least 2 hours. * **Digoxin:** Hypercalcemia can potentiate digoxin toxicity. * **Thiazide Diuretics:** Can increase serum calcium levels. Increased risk of hypercalcemia. * **Vitamin D:** Enhances calcium absorption. ## Monitoring * Serum calcium levels (especially with IV administration and in impaired renal function). * ECG (particularly with rapid IV administration or in patients with cardiac conditions). * Signs and symptoms of hypocalcemia or hypercalcemia. ## Clinical Pearls * Intravenous calcium gluconate is less irritating than calcium chloride if extravasation occurs, but it contains less elemental calcium per volume (90 mg vs. 272 mg). * When administering IV calcium, ensure a patent IV line to prevent extravasation. Do not administer through the same line as sodium bicarbonate or phosphate solutions due to precipitation risk. * Oral calcium absorption is best when taken with meals. *** **Disclaimer:** This information is intended for healthcare professionals and is not a substitute for professional medical judgment. Always consult the most current prescribing information and institutional protocols before administering any medication.