From the Guidelines
The recommended initial dose of calcium gluconate for treating hypocalcemia is 50-100 mg/kg, which can be infused and cautiously repeated if necessary, as suggested by the most recent and highest quality study 1.
Key Considerations
- The dose of calcium gluconate should be administered intravenously, and patients should be monitored for signs of hypercalcemia such as nausea, vomiting, and cardiac arrhythmias.
- Asymptomatic hypocalcemia does not require treatment, but symptomatic cases, such as tetany and seizures, necessitate immediate intervention with calcium gluconate.
- The treatment with calcium gluconate addresses immediate symptoms while the underlying cause of hypocalcemia is being investigated and treated.
Administration Guidelines
- The initial dose of calcium gluconate can be infused slowly over 10-20 minutes.
- For children, the dose should not exceed the maximum recommended amount, and the infusion rate should be adjusted according to the patient's weight and response to treatment.
- Calcium gluconate is preferred over calcium chloride for peripheral administration because it causes less tissue irritation if extravasation occurs.
Monitoring and Follow-up
- Patients should be closely monitored for signs of hypercalcemia, and the treatment should be adjusted accordingly.
- Oral calcium supplementation should be initiated once the acute phase has resolved to maintain normal calcium levels.
- The underlying cause of hypocalcemia should be investigated and treated to prevent recurrence of the condition.
From the FDA Drug Label
Contains 100 mg of calcium gluconate per mL which contains 9.3 mg (0. 465 mEq) of elemental calcium Individualize the dose within the recommended range in adults and pediatric patients depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia. See Table 1 in the FPI for dosing recommendations in mg of calcium gluconate for neonates, pediatric and adult patients.
The recommended initial dose of calcium gluconate for treating hypocalcemia is not explicitly stated in the provided drug label. However, it is mentioned that the dose should be individualized based on the severity of symptoms, serum calcium level, and acuity of onset of hypocalcemia, and that Table 1 in the Full Prescribing Information (FPI) provides dosing recommendations. Key considerations for dosing include:
- Severity of symptoms
- Serum calcium level
- Acuity of onset of hypocalcemia It is recommended to consult the FPI for specific dosing guidelines 2.
From the Research
IV Dose Calcium Gluconate for Treating Hypocalcemia
- The recommended initial dose of calcium gluconate for treating hypocalcemia is 10-20 mL of 10% calcium gluconate in 50-100 mL of 5% dextrose IV over 10 minutes with ECG monitoring 3.
- This dose can be repeated until the patient is asymptomatic, and then followed up with a calcium gluconate infusion of 100 mL of 10% calcium gluconate diluted in 1 L of normal saline or 5% dextrose, infused at 50-100 mL/h 3.
- Calcium chloride can be used as an alternative to calcium gluconate, but it is more irritant to veins and should only be given via a central line 3.
- The dose equivalence of calcium gluconate and calcium chloride is as follows: 10 mL of 10% calcium gluconate contains 2.2 mmol of calcium, and 4.4 mL of 7.35% calcium chloride or 2.2 mL of 14.7% calcium chloride should be used as equivalent to 10 mL of 10% calcium gluconate 3.
Key Considerations
- Parenteral formulations of calcium compounds must meet pharmacopoeial requirements, including the aluminum content limit 4.
- Calcium gluconate is preferred over calcium chloride due to its considerably less irritation of the vessel wall and better compatibility with other nutrients in parenteral nutrition 4.
- The role of calcium replacement in septic patients remains unclear and requires further study 4.