From the FDA Drug Label
Calcium Gluconate Injection is a form of calcium indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia. 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. Measure serum calcium during intermittent infusions every 4 to 6 hours and during continuous infusion every 1 to 4 hours.
The treatment for hypocalcemia using calcium supplements is intravenous administration of calcium gluconate. The dose should be individualized based on the severity of symptoms, serum calcium level, and acuity of onset. Serum calcium levels should be monitored every 4 to 6 hours during intermittent infusions and every 1 to 4 hours during continuous infusion 1.
From the Research
For the treatment of hypocalcemia, oral calcium supplements such as calcium carbonate or calcium citrate are recommended, with calcium citrate being preferred for patients with achlorhydria or those taking proton pump inhibitors, and intravenous calcium gluconate for severe symptomatic cases, as supported by the most recent and highest quality study 2.
Treatment Approach
The treatment approach for hypocalcemia involves:
- Oral calcium supplements for mild to moderate cases
- Intravenous calcium gluconate for severe symptomatic cases
- Vitamin D supplementation to enhance intestinal calcium absorption
Oral Calcium Supplements
- Calcium carbonate (containing 40% elemental calcium) at doses of 1000-2000 mg elemental calcium daily, divided into 2-4 doses
- Calcium citrate may be preferred for patients with achlorhydria or those taking proton pump inhibitors as it doesn't require stomach acid for absorption
Intravenous Calcium Gluconate
- 10% solution, providing 90 mg elemental calcium per 10 mL
- May be administered at 1-2 ampules over 10-20 minutes, followed by a continuous infusion if needed
Vitamin D Supplementation
- Cholecalciferol 1000-2000 IU daily or calcitriol 0.25-0.5 mcg daily
- Accompanies calcium supplementation to enhance intestinal calcium absorption
Monitoring and Side Effects
- Patients should be monitored for serum calcium levels, symptoms of hypercalcemia, and potential side effects like constipation or kidney stones
- The underlying cause of hypocalcemia should also be identified and addressed, as this may involve parathyroid disorders, vitamin D deficiency, or kidney disease, as noted in 3 and 4.