How to administer calcium gluconate via injection?

Administration of Calcium Gluconate Injection

Calcium gluconate should be administered intravenously at a rate not exceeding 200 mg/minute in adults or 100 mg/minute in pediatric patients, with careful monitoring of vital signs and ECG during administration. 1

Preparation and Administration Guidelines

Formulation and Concentration

• Calcium Gluconate Injection contains 100 mg of calcium gluconate per mL, which provides 9.3 mg (0.465 mEq) of elemental calcium 1
• A 10-mL ampule of 10% calcium gluconate contains 90 mg of elemental calcium 2

Administration Routes and Methods

• Administer intravenously via a secure intravenous line to avoid calcinosis cutis and tissue necrosis 1
• Central venous access is preferred, especially for calcium chloride, but calcium gluconate can be administered through a peripheral IV if necessary 3
• For bolus administration:
  • Dilute calcium gluconate in 5% dextrose or normal saline to a concentration of 10-50 mg/mL prior to administration 1
  • Administer slowly at a rate not exceeding 200 mg/minute in adults or 100 mg/minute in pediatric patients 1
• For continuous infusion:
  • Dilute to a concentration of 5.8-10 mg/mL in 5% dextrose or normal saline 1

Monitoring During Administration

• Monitor heart rate, blood pressure, and ECG during administration 1
• Stop injection if symptomatic bradycardia occurs 3
• For continuous infusions, measure serum calcium every 1 to 4 hours 1
• For intermittent infusions, measure serum calcium every 4 to 6 hours 1

Clinical Applications and Dosing

Emergency Cardiac Protection in Hyperkalemia

• For cardiac protection in hyperkalemia: Administer calcium gluconate (10%) 15-30 mL IV over 2-5 minutes 3
• Calcium rapidly antagonizes the effect of potassium on cardiac tissue within 1-3 minutes 3
• Repeat dosing may be given if no effect is observed within 5-10 minutes 3

Hypocalcemia Management

• For mild hypocalcemia (ionized calcium 1-1.12 mmol/L): 1-2 g IV calcium gluconate 4
• For moderate to severe hypocalcemia (ionized calcium <1 mmol/L): 4 g IV calcium gluconate infused at 1 g/hour 5
• For severe hypocalcemia (<1.9 mmol/L or symptomatic): Initially give 10-20 mL of 10% calcium gluconate in 50-100 mL of 5% dextrose IV over 10 minutes with ECG monitoring 6
• For maintenance infusion in severe hypocalcemia: Dilute 100 mL of 10% calcium gluconate in 1 L of normal saline or 5% dextrose and infuse at 50-100 mL/h 6

Hypermagnesemia Management

• For cardiac arrest associated with hypermagnesemia: Administration of calcium gluconate (10%) 15-30 mL IV may be considered 2

Calcium Channel Blocker Toxicity

• For calcium channel blocker toxicity: Infuse 20 mg/kg (0.2 mL/kg) of 10% calcium chloride intravenously over 5-10 minutes; if beneficial, give an infusion of 20-50 mg/kg per hour 2
• If using calcium gluconate instead: 60 mg/kg dose may be substituted 3
• For refractory shock: One approach is to administer 0.3 mEq/kg of calcium (0.6 mL/kg of 10% calcium gluconate) IV over 5-10 minutes, followed by an infusion of 0.3 mEq/kg per hour 2

Special Considerations

Pediatric Dosing

• For pediatric patients with hyperkalemia: Calcium gluconate dose is 60 mg/kg 3
• Do not exceed infusion rate of 100 mg/minute in pediatric patients 1

Incompatibilities and Precautions

• Do not mix calcium gluconate with:
  • Ceftriaxone (can form precipitates) 1
  • Fluids containing bicarbonate or phosphate 1
  • Minocycline injection 1
• Use caution when administering calcium in patients with high phosphate levels, as it may increase risk of calcium phosphate precipitation 2
• Inspect solution visually before administration - it should appear clear and colorless to slightly yellow 1

By following these guidelines for calcium gluconate administration, clinicians can effectively manage conditions requiring calcium supplementation while minimizing risks associated with improper administration.