calcium gluconate injection
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Calcium Gluconate Injection
Formulation
- 10% solution (100 mg/mL) - the standard preparation
- Each 10 mL ampule = 1000 mg calcium gluconate = ~90-93 mg elemental calcium
- Contains 9.3% elemental calcium (4.65 mEq or 2.33 mmol elemental Ca per gram of salt)
- Also available as a ready-to-use 20 mg/mL solution in 0.675% NaCl
- May contain aluminum (up to 512 mcg/1000 mL) - important in renal impairment
Why Calcium Gluconate is Preferred Over Calcium Chloride (Peripheral Use)
| Feature | Calcium Gluconate | Calcium Chloride |
|---|---|---|
| Elemental Ca per mL (10%) | 8.9 mg (0.22 mmol) | 27.2 mg (0.68 mmol) |
| Peripheral IV line | Yes - safe | No - causes tissue necrosis if it extravasates |
| Irritation on extravasation | Minimal | Severe necrosis |
| Route | Peripheral or central | Central line required |
Calcium gluconate is the preferred agent for peripheral IV use because it is far less irritating to veins. Calcium chloride has 3x more elemental calcium per mL but requires a central line. Efficacy and onset are otherwise equivalent for both forms in normal hepatic function. - Brenner and Rector's The Kidney
Clinical Indications & Dosing
1. Hypocalcemia (Symptomatic / Acute)
Adults:
- Initial: 10-20 mL of 10% calcium gluconate at 5 mL/min IV
- Followed by continuous infusion: 10% calcium gluconate in 500 mL fluid over 6 hours
- Maintenance: 0.5-8 g/24 hr IV or PO divided Q6 hr
- Miller's Anesthesia; Washington Manual
Pediatric (Harriet Lane doses - all expressed as mg calcium gluconate):
| Age | Maintenance IV dose |
|---|---|
| Neonate | 200-800 mg/kg/24 hr ÷ Q6 hr |
| Infant | 200-500 mg/kg/24 hr ÷ Q6 hr |
| Child | 200-500 mg/kg/24 hr ÷ Q6 hr |
| Adult | 0.5-8 g/24 hr ÷ Q6 hr |
- Harriet Lane Handbook, 23rd ed.
2. Tetany
| Population | Dose |
|---|---|
| Neonate/Infant/Child | 100-200 mg/kg/dose IV over 5-10 min; repeat at 6 hr if needed; max 500 mg/kg/24 hr |
| Adult | 0.5-2 g IV over 10-30 min; repeat at 6 hr if needed |
3. Hyperkalemia - Cardiac Protection (First-Line)
Calcium does not lower potassium - it antagonizes the cardiac membrane effects of hyperkalemia by raising the action potential threshold and restoring normal myocardial conduction velocity (Vmax).
-
Dose: 10 mL of 10% calcium gluconate IV over 2-3 minutes under continuous ECG monitoring
-
Onset: 1-3 minutes; Duration: 30-60 minutes
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Repeat if no ECG improvement or if changes recur after initial improvement
-
Caution in digoxin toxicity: Hypercalcemia potentiates digitalis toxicity. In digitalized patients, dilute 10 mL of 10% calcium gluconate in 100 mL D5W and infuse over 20-30 minutes
-
Brenner and Rector's The Kidney
4. Cardiac Arrest (Hypocalcemia-related)
| Population | Dose |
|---|---|
| Infant/Child | 60 mg/kg/dose (max 3000 mg/dose) IV Q10-20 min PRN |
| Adult | 1.5-3 g/dose IV Q10 min PRN; max 3 g/dose |
Note: Routine use in cardiac arrest is not recommended due to lack of improved survival evidence.
Maximum IV Administration Rates
- IV push: Do not exceed 100 mg/min (can give over 10-20 sec in cardiac arrest)
- IV infusion: Do not exceed 200 mg/min; maximum concentration 50 mg/mL
Important Precautions
- Before giving IV calcium: Always check serum phosphorus first. In severe hyperphosphatemia (>6.5 mg/dL), IV calcium can raise the Ca-Phos product and worsen ectopic calcification. Dialysis may be needed in this scenario.
- Hypomagnesemia must be corrected first - it prevents effective correction of hypocalcemia.
- ECG monitoring is mandatory during rapid IV infusion (risk of bradycardia, hypotension, arrhythmias).
- Do NOT administer via scalp veins, IM, or SC routes.
- Do NOT mix with sodium bicarbonate or ceftriaxone (precipitation).
- Ventricular fibrillation: Contraindicated.
- Renal impairment: Use caution - risk of hypercalcemia and aluminum accumulation.
- Avoid peripheral infusion of concentrated solutions - extravasation can cause tissue necrosis.
Drug Interactions (oral route)
Reduces absorption of: fluoroquinolones, tetracyclines, iron supplements, and effectiveness of polystyrene sulfonate (kayexalate).
Sources: Washington Manual of Medical Therapeutics; Harriet Lane Handbook 23rd ed.; Brenner and Rector's The Kidney; Miller's Anesthesia 10th ed.
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