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# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt used to treat or prevent low blood calcium levels.
## Primary Indications
* Hypocalcemia
* Adjunctive treatment in acute hyperkalemia (to stabilize cardiac membrane)
* Magnesium sulfate toxicity
* Treatment of hydrofluoric acid burns (topical)
## Adult Dosing
* **Hypocalcemia:** Dosing is highly variable and depends on the severity of hypocalcemia and clinical presentation. Intravenous (IV) administration is typically reserved for symptomatic hypocalcemia.
* **Symptomatic Hypocalcemia (e.g., tetany, seizures):** 10 mL of 10% calcium gluconate solution (equivalent to 90 mg elemental calcium or 4.5 mEq) IV may be administered slowly over 5-10 minutes. Repeat doses may be given every 6 hours as needed based on serum calcium levels and clinical response. Maximum dose not well-established but should be guided by continuous monitoring.
* **Asymptomatic Hypocalcemia:** Oral calcium gluconate is preferred. Typical oral doses range from 1 to 2 grams of elemental calcium daily, divided into multiple doses.
* **Adjunctive in Hyperkalemia:** 10 mL of 10% calcium gluconate IV over 2-5 minutes. This does not lower potassium but stabilizes the cardiac membrane against the effects of hyperkalemia.
* **Magnesium Sulfate Toxicity:** 10 mL of 10% calcium gluconate IV, repeated every minute as needed up to a total of 30 mL, or until reversal of symptoms.
* **Hydrofluoric Acid Burns (Topical):** Gel or solution applied liberally to affected areas.
## Pediatric Dosing
* **Hypocalcemia:** Dosing is weight-based and depends on the severity.
* **Symptomatic Hypocalcemia:** 0.5 to 1 mL/kg of 10% calcium gluconate IV administered slowly over 10-20 minutes. Maximum dose not well-established. May require continuous infusion in some cases.
* **Asymptomatic Hypocalcemia:** Oral calcium gluconate is preferred. Dosing varies by age and specific condition.
## Dose Adjustments
No specific dose adjustments are routinely recommended for renal or hepatic impairment, but caution is advised, especially in severe renal disease, due to potential for hypercalcemia.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Administration of calcium gluconate IV in the same IV line as sodium bicarbonate or phosphate solutions, as this can lead to precipitation.
## Adverse Effects
* **IV:** Hypotension, bradycardia, arrhythmias, phlebitis, local tissue necrosis (if extravasation occurs), warmth, tingling, chalky taste.
* **Oral:** Constipation, nausea, vomiting, abdominal pain.
* **Hypercalcemia:** Symptoms include nausea, vomiting, constipation, abdominal pain, confusion, lethargy, polyuria, polydipsia, kidney stones.
## Key Drug Interactions
* **Digoxin:** Increased risk of digoxin toxicity if hypercalcemia occurs.
* **Tetracyclines and Quinolones:** Calcium can decrease absorption. Separate administration by at least 2 hours before or 4-6 hours after.
* **Bisphosphonates, Thyroid Hormones, Iron Supplements:** Calcium can decrease absorption. Separate administration.
* **Thiazide Diuretics:** Can increase serum calcium levels.
* **Vitamin D Analogs:** Can potentiate the effect of calcium.
## Monitoring
* Serum calcium levels (total and ionized)
* ECG (especially in symptomatic hypocalcemia or hyperkalemia treatment)
* Renal function
* Signs and symptoms of hypocalcemia or hypercalcemia
## Clinical Pearls
* When administering IV calcium gluconate, it must be given slowly and ideally through a central line to prevent phlebitis and tissue damage. Monitor closely for extravasation.
* Always check serum calcium levels before and after administration to guide further dosing.
* Oral calcium gluconate has a lower elemental calcium content and is less irritating to the GI tract than calcium chloride.
* The 10% solution of calcium gluconate contains 90 mg of elemental calcium per 10 mL.
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***Disclaimer:** This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols for definitive guidance.*
