| CALCIUM GLUCONATe
Classifications: fluid and electrolytic replacement solution; Therapeutic: fluid and electrolyte replacement solution
Pregnancy Category: B
500 mg, 650 mg, 975 mg, 1 g tablets; 10% injection
Calcium gluconate acts like digitalis on the heart, increasing cardiac muscle tone and force of systolic contractions (positive
Rapidly and effectively restores serum calcium levels in acute hypocalcemia of various origins and effective as a cardiac
stabilizer under conditions of hyperkalemia or resuscitation.
Negative calcium balance (as in neonatal tetany, hypoparathyroidism, vitamin D deficiency, alkalosis). Also to overcome cardiac
toxicity of hyperkalemia, for cardiopulmonary resuscitation, to prevent hypocalcemia during transfusion of citrated blood.
Also as antidote for magnesium sulfate, for acute symptoms of lead colic, to decrease capillary permeability in sensitivity
reactions, and to relieve muscle cramps from insect bites or stings. Oral calcium may be used to maintain normal calcium
balance during pregnancy, lactation, and childhood growth and to prevent primary osteoporosis. Also in osteoporosis, osteomalacia,
chronic hypoparathyroidism, rickets, and as adjunct in treatment of myasthenia gravis and Eaton-Lambert syndrome.
To antagonize aminoglycoside-induced neuromuscular blockage, and as "calcium challenge" to diagnose Zollinger-Ellison
syndrome and medullary thyroid carcinoma.
Ventricular fibrillation, metastatic bone disease, injection into myocardium; administration by SC or IM routes; renal calculi,
hypercalcemia, predisposition to hypercalcemia (hyperparathyroidism, certain malignancies); digitalis toxicity.
Digitalized patients, renal or cardiac insufficiency, arrhythmias; dehydration; diarrhea; hyperphosphatemia; sarcoidosis,
history of lithiasis, immobilized patients; pregnancy (category B).
Route & Dosage
All doses are in terms of elemental calcium: 1 g calcium gluconate = 90 mg (4.5 mEq, 9.3%) elemental calcium
Supplement for Osteoporosis
Adult: PO 12 g b.i.d. to q.i.d. IV 7 mEq q13d
Child: PO 4565 mg/kg/d in divided doses. IV 17 mEq q13d
Neonate: PO 50130 mg/kg/d (max: 1 g)
Adult: IV 215 g/d continuous or divided dose
Child: IV 200500 mg/kg/d (max: 23 g/dose)
Neonate: IV Not more than 0.93 mEq
Adult: IV 13 g prn
Child: IV 100200 mg/kg/dose, may repeat q68h
Neonate: IV 200 mg followed by 500 mg/kg/d infusion
Adult: IV 2.33.7 mEq x 1
Hyperkalemia with Cardiac Toxicity
Adult: IV 500800 mg (max dose: 3 g)
Exchange Transfusions with Citrated Blood
Adult: IV 5001000 mg for each 500 mL of blood
Neonate: IV 98 mg for each 100 mL of blood
- Ensure that chewable tablets are chewed or crushed before being swallowed with a liquid.
- Give with meals to enhance absorption.
PREPARE: Direct: May be given undiluted. Intermittent/Continuous: May be diluted in 1000 mL of NS.
ADMINISTER: Direct: Give direct IV at a rate of 0.5 mL or a fraction thereof over 1 min. Do not exceed 2 mL/min. Intermittent/Continuous: Give slowly, not to exceed 200 mg/min for adults or 100 mg/min for children. Use a small-bore needle into a large vein to
avoid possibility of extravasation and resultant necrosis. With children, scalp veins should be avoided. Avoid rapid infusion.
High concentrations of calcium suddenly reaching the heart can cause fatal cardiac arrest.
INCOMPATIBILITIES Solution/additive: Amphotericin B, cefamandole, dobutamine, methylprednisolone, metoclopramide, concentration-dependent incompatibility with other electrolytes. Y-site: Amphotericin B cholesteryl complex, fluconazole, indomethacin, lansoprazole, meropenem.
- Injection should be stopped if patient complains of any discomfort.
- Patient should be advised to remain in bed for 1530 min or more following injection, depending on response.
Adverse Effects (≥1%)Body as a Whole:
Tingling sensation. With rapid IV
, sensations of heat waves (peripheral vasodilation), fainting. GI:
PO preparation: Constipation
, increased gastric acid secretion. CV:
(With rapid infusion) hypotension, bradycardia, cardiac arrhythmias, cardiac arrest. Skin:
Pain and burning at IV
site, severe venous thrombosis, necrosis and sloughing (with extravasation).
Diagnostic Test Interference
IV calcium may cause false decreases in serum and urine magnesium (by Titan yellow method) and transient elevations of plasma 11-OHCS levels by Glenn-Nelson technique. Values usually return to control levels after 60 min; urinary steroid values (17-OHCS) may be decreased.
May enhance inotropic and toxic effects of digoxin; magnesium
may compete for GI absorption; decreases absorption of tetracyclines
); antagonizes the effects of verapamil
and possibly other calcium channel blockers
30% from small intestine. Onset:
Immediately after IV
Crosses placenta. Elimination:
Primarily in feces; small amounts in urine, pancreatic juice, saliva, and breast milk.
Assessment & Drug Effects
- Assess for cutaneous burning sensations and peripheral vasodilation, with moderate fall in BP, during direct IV injection.
- Monitor ECG during IV administration to detect evidence of hypercalcemia: decreased QT interval associated with inverted
- Observe IV site closely. Extravasation may result in tissue irritation and necrosis.
- Monitor for hypocalcemia and hypercalcemia (see Signs & Symptoms, Appendix F).
- Lab tests: Determine levels of calcium and phosphorus (tend to vary inversely) and magnesium frequently, during sustained
therapy. Deficiencies in other ions, particularly magnesium, frequently coexist with calcium ion depletion.
Patient & Family Education
- Report S&S of hypercalcemia (see Appendix F) promptly to your care provider.
- Milk and milk products are the best sources of calcium (and phosphorus). Other good sources include dark green vegetables,
soy beans, tofu, and canned fish with bones.
- Calcium absorption can be inhibited by zinc-rich foods: nuts, seeds, sprouts, legumes, soy products (tofu).
- Check with physician before self-medicating with a calcium supplement.