From the FDA Drug Label
2 DOSAGE & ADMINISTRATION
2.1 Important Administration Instructions Calcium Gluconate Injection contains 100 mg of calcium gluconate per mL which contains 9.3 mg (i.e., 0.465 mEq) of elemental calcium. ... 2.2 Recommended Dosage Individualize the dose of Calcium Gluconate Injection within the recommended range depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia. Table 1 provides dosing recommendations for Calcium Gluconate Injection in mg of calcium gluconate for neonates, pediatric and adult patients.
The maximum recommended daily dose of calcium gluconate is not explicitly stated in the drug label. However, the label provides dosing recommendations in Table 1 for different age groups, and it recommends individualizing the dose based on the severity of symptoms and serum calcium levels. Key considerations:
- The dose should be individualized based on the severity of symptoms and serum calcium levels.
- The label recommends monitoring serum calcium levels every 4 to 6 hours during intermittent infusions and every 1 to 4 hours during continuous infusion. 1
From the Research
The maximum recommended daily dose of calcium gluconate should not exceed 2-4 grams, equivalent to 180-360 mg of elemental calcium, to minimize the risk of hypercalcemia and its associated morbidity and mortality. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of careful dosing to avoid excessive calcium intake 2.
Key Considerations
- Calcium gluconate contains only about 9% elemental calcium, so dosing calculations must account for this to avoid over-supplementation.
- Patients should not exceed these recommendations without medical supervision, as excessive calcium can lead to hypercalcemia, causing symptoms like nausea, vomiting, constipation, confusion, and in severe cases, cardiac arrhythmias and kidney stones.
- Calcium supplements should be taken with food to enhance absorption and should be spaced apart from certain medications like tetracycline antibiotics and bisphosphonates, which can interact with calcium.
- Vitamin D status affects calcium absorption, so adequate vitamin D levels are important for optimal calcium utilization.
Risks of Excessive Calcium Intake
- Hypercalcemia can lead to severe symptoms, including nausea, vomiting, dehydration, confusion, somnolence, and coma, as reported in a recent review on hypercalcemia 3.
- Excessive calcium intake has been associated with an increased risk of advanced and fatal prostate cancer, as well as renal calculi, highlighting the importance of careful dosing and monitoring 2.
Monitoring and Management
- Patients receiving calcium gluconate should be closely monitored for signs of hypercalcemia and other adverse effects.
- Serum calcium levels should be regularly checked to ensure that they remain within the normal range.
- In cases of suspected hypercalcemia, treatment should be initiated promptly to prevent complications and improve outcomes, as outlined in recent guidelines on the management of hypercalcemia 3.