Uses of Calcium Gluconate
Calcium gluconate is primarily indicated for the treatment of acute symptomatic hypocalcemia in both pediatric and adult patients. 1
Primary Clinical Applications
1. Hypocalcemia Management
- Acute symptomatic hypocalcemia: FDA-approved primary indication 1
- Mild hypocalcemia: 1-2g IV calcium gluconate effective in normalizing ionized calcium in 79% of patients 2
- Moderate to severe hypocalcemia: 4g IV calcium gluconate infusion (at 1g/hour) achieves normalization in 95% of critically ill patients 3
2. Specific Emergency Situations
- Cardiac arrest associated with:
- Hyperkalemia
- Hypermagnesemia
- Hypocalcemia
- Calcium channel blocker toxicity 4
3. Post-Parathyroidectomy Management
- After parathyroidectomy, calcium gluconate infusion (1-2 mg elemental calcium/kg/hour) is recommended when blood ionized calcium falls below normal (<0.9 mmol/L) 4
Administration Routes and Dosing
Intravenous Administration
- Cardiac arrest situations: 10% calcium gluconate 15-30 mL IV over 2-5 minutes 4
- Post-parathyroidectomy: Initial infusion of 1-2 mg elemental calcium/kg/hour (10 mL of 10% calcium gluconate contains 90 mg elemental calcium) 4
- Calcium channel blocker toxicity: High-dose calcium may be effective for hemodynamically unstable patients 4
Oral Administration
- Rarely used for oral supplementation due to low elemental calcium content (9%) compared to calcium carbonate (40%) 5
Special Considerations
Monitoring Requirements
- Ionized calcium levels should be monitored during treatment 5, 6
- ECG monitoring is recommended during rapid IV administration 7
- Serum phosphorus should be monitored, especially in patients with hyperphosphatemia 5
Administration Precautions
- Preferably administered through a central venous line to avoid tissue injury 5
- Not compatible with fluids containing phosphate or bicarbonate 5
- Rapid IV administration may cause vasodilation, hypotension, bradycardia, arrhythmias, and cardiac arrest 5
Efficacy Considerations
- Calcium supplementation may not improve mortality in critically ill patients with hypocalcemia 6
- Failure to normalize calcium levels in severely hypocalcemic patients may be associated with increased mortality 6
Limitations
- The safety of calcium gluconate for long-term use has not been established 1
- Adjusted calcium is not a good surrogate for ionized calcium in ICU settings 6
Calcium gluconate remains an essential medication for managing acute hypocalcemia and specific emergency situations, but careful monitoring and appropriate administration are crucial for safe and effective treatment.