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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 (IV) formulations.
## Primary Indications
* Hypocalcemia (treatment and prevention)
* Cardiac resuscitation in hyperkalemia (IV)
* Management of hydrofluoric acid burns (topical)
## Adult Dosing
* **Hypocalcemia:**
* Oral: Dosing varies based on elemental calcium need, typically 1-2 grams of elemental calcium daily in divided doses. Calcium gluconate contains 9% elemental calcium (e.g., 1 gram of calcium gluconate provides 90 mg elemental calcium).
* IV: 1-2 grams (10-20 mL of 10% solution) administered slowly, typically over 5-10 minutes. Higher doses may be required for severe hypocalcemia or cardiac arrest, often guided by physician protocol and serum calcium levels.
* **Cardiac Resuscitation in Hyperkalemia (IV):** 1 gram (10 mL of 10% solution) IV push, repeated every 5-10 minutes as needed and guided by ECG changes.
* **Hydrofluoric Acid Burns (Topical):** 2.5% topical gel or solution applied continuously.
## Pediatric Dosing
* **Hypocalcemia:**
* Oral: Dosing varies based on elemental calcium need, typically 45-65 mg/kg/day of elemental calcium in divided doses.
* IV: 100-200 mg/kg (1-2 mL/kg of 10% solution) administered IV slowly over 10-20 minutes. Maximum single dose typically 1 gram. Higher doses may be needed for severe cases, guided by serum calcium levels and physician protocol.
* **Cardiac Resuscitation in Hyperkalemia (IV):** 100 mg/kg (1 mL/kg of 10% solution) IV, repeated every 5-10 minutes as needed and guided by ECG changes.
## Dose Adjustments
No specific dose adjustments are typically required for renal or hepatic impairment, though caution is advised in severe renal disease due to potential calcium accumulation. Electrolyte and acid-base balance should be monitored.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Known hypersensitivity to calcium gluconate
## Adverse Effects
Common: Constipation (oral), nausea, vomiting, abdominal pain.
IV: Hypotension, vasodilation, local irritation, phlebitis. Rapid IV administration can cause cardiac arrhythmias, bradycardia, and cardiac arrest. Extravasation can lead to tissue necrosis.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Oral calcium can decrease absorption; separate administration by at least 2 hours.
* **Bisphosphonates, Thyroid Hormones, Iron Supplements:** Oral calcium can decrease absorption; separate administration by at least 2 hours.
* **Thiazide Diuretics:** May increase serum calcium levels.
* **Digoxin:** Hypercalcemia increases the risk of digoxin toxicity.
* **Calcium Channel Blockers:** IV calcium may decrease the effectiveness of calcium channel blockers.
## Monitoring
* Serum calcium levels
* Renal function
* Signs and symptoms of hypercalcemia or hypocalcemia
* ECG changes (especially with IV administration for hyperkalemia)
## Clinical Pearls
* Oral calcium gluconate is less irritating than calcium chloride but contains less elemental calcium per gram.
* For IV administration, ensure the calcium gluconate is in a compatible IV solution and administered slowly to prevent adverse cardiovascular effects.
* Always confirm the concentration of IV calcium gluconate (e.g., 10% solution contains 0.92 mEq or 4.6 mEq of elemental calcium per 10 mL).
* Topical calcium gluconate is the treatment of choice for hydrofluoric acid burns to precipitate fluoride ions.
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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.*
