Please check your internet connection and try again.
# Calcium Gluconate
## Overview
Calcium gluconate is an inorganic salt used to treat or prevent low blood calcium levels. It is available in oral and intravenous (IV) formulations.
## Primary Indications
* Hypocalcemia
* Cardiac resuscitation in hyperkalemia
* Adjunctive treatment in magnesium sulfate overdose
* Treatment of hydrofluoric acid burns (topical)
## Adult Dosing
* **Hypocalcemia (IV):** 1 to 2 grams (10 to 20 mL of 10% solution) administered slowly IV over 10-30 minutes. May be repeated every 6 hours as needed. For severe symptomatic hypocalcemia, a continuous infusion may be initiated at a rate of 1-2 g/hour.
* **Cardiac Resuscitation in Hyperkalemia (IV):** 1 to 3 grams (10 to 30 mL of 10% solution) IV push. This does not lower potassium levels but can stabilize cardiac membranes.
* **Magnesium Sulfate Overdose (IV):** 1 to 3 grams (10 to 30 mL of 10% solution) IV.
* **Oral Supplementation:** Varies widely based on elemental calcium needs, typically ranging from 500 mg to 2000 mg elemental calcium daily, divided into doses. (1 gram calcium gluconate contains approximately 90 mg elemental calcium).
## Pediatric Dosing
* **Hypocalcemia (IV):** 0.5 to 1 mL/kg (50 to 100 mg/kg) of 10% calcium gluconate solution administered IV over 10-30 minutes. Maximum dose of 10 mL (1 gram). May be repeated every 4-6 hours.
* **Oral Supplementation:** Varies widely based on elemental calcium needs.
## Dose Adjustments
No specific dose adjustments are required for renal or hepatic impairment, but caution is advised in these populations due to potential for calcium accumulation.
## Contraindications
* Hypercalcemia
* Ventricular fibrillation
* Severe renal impairment (use IV with extreme caution)
* History of calcium-containing kidney stones (oral use)
* Sarcoidosis
## Adverse Effects
* **IV:** Hypotension, bradycardia, cardiac arrhythmias, phlebitis, local tissue necrosis (if extravasation occurs), tingling sensation. Rapid IV infusion can cause "calcium glugging" sensation, metallic taste, hot flashes.
* **Oral:** Constipation, abdominal discomfort, nausea.
## Key Drug Interactions
* **Digoxin:** Increased risk of arrhythmias.
* **Tetracyclines and Fluoroquinolones:** Calcium can decrease absorption; separate administration by at least 2 hours.
* **Bisphosphonates and Thyroid Hormones:** Calcium can decrease absorption; separate administration.
* **Thiazide Diuretics:** Increased risk of hypercalcemia.
* **Vitamin D:** Enhances calcium absorption.
## Monitoring
* Serum calcium levels (frequently, especially with IV administration)
* Renal function
* Cardiac rhythm (especially with IV administration)
## Clinical Pearls
* Always administer IV calcium gluconate slowly and via a central line if possible to minimize phlebitis and extravasation risk.
* Do NOT administer IV calcium through the same IV line as sodium bicarbonate or sodium phosphate due to potential for precipitation.
* For IV use in neonates, avoid rapid infusion to prevent bradycardia.
* Oral calcium carbonate is generally preferred for routine calcium supplementation due to higher elemental calcium content and lower cost, but calcium gluconate may be better tolerated in patients with achlorhydria.
***
*Disclaimer: This information is intended for healthcare professionals and does not replace comprehensive drug information resources. Always consult the most current prescribing information and institutional protocols before administering any medication.*
