Recommended Dose of Calcium Gluconate Infusion for Severe Symptomatic Hypocalcemia
For severe symptomatic hypocalcemia, administer 60 mg/kg of calcium gluconate intravenously, infused over 30-60 minutes with ECG monitoring. 1
Dosing Algorithm Based on Severity
Severe Symptomatic Hypocalcemia
- Initial dose: 60 mg/kg calcium gluconate IV 1
- Administration rate: Infuse over 30-60 minutes
- Monitoring: Continuous ECG monitoring during infusion
- Alternative: If calcium chloride is available, 20 mg/kg (0.2 mL/kg of 10% CaCl₂) is preferred for critically ill patients 1
For Ongoing Management
- Continuous infusion approach: 0.3 mEq/kg/hour of calcium (equivalent to approximately 0.6 mL/kg/hour of 10% calcium gluconate) 1
- Titration: Based on ionized calcium levels and hemodynamic response
- Monitoring: Check ionized calcium every 1-4 hours during continuous infusion 2
Important Administration Considerations
- Central venous access: Preferred route for administration, especially for continuous infusions 1
- Peripheral IV risk: Extravasation through peripheral IV can cause severe skin and soft tissue injury 1
- Incompatibilities: Do not mix with fluids containing phosphate or bicarbonate as precipitation may occur 2
- ECG monitoring: Essential during administration to detect bradycardia or arrhythmias 1
- Stop infusion: If symptomatic bradycardia occurs 1
Evidence-Based Outcomes
Research studies have evaluated specific dosing regimens with the following results:
- For moderate to severe hypocalcemia (ionized Ca <1.0 mmol/L), a 4g infusion of calcium gluconate at 1g/hour was successful in 95% of patients to achieve ionized calcium >1.0 mmol/L 3
- For mild hypocalcemia (ionized Ca 1.0-1.12 mmol/L), 1-2g of IV calcium gluconate normalized calcium in 79% of patients 4
- Approximately half of the administered calcium dose is retained in the exchangeable calcium space 5
Special Populations
Pediatric Patients
- Same weight-based dosing of 60 mg/kg applies 1
- For symptomatic hypocalcemia in children, calcium gluconate 50-100 mg/kg IV administered slowly with ECG monitoring 1
Post-Parathyroidectomy Patients
- If ionized calcium falls below normal (<0.9 mmol/L), initiate calcium gluconate infusion at 1-2 mg elemental calcium per kg body weight per hour 1
- A 10-mL ampule of 10% calcium gluconate contains 90 mg of elemental calcium 1
Monitoring Parameters
- During intermittent infusions: Measure serum calcium every 4-6 hours 2
- During continuous infusion: Check ionized calcium every 1-4 hours 2
- Post-infusion: Ionized calcium levels stabilize approximately 10 hours after completion of infusion 5
Cautions and Contraindications
- Hypercalcemia: Absolute contraindication 2
- Concurrent ceftriaxone use: Contraindicated in neonates due to risk of fatal precipitates 2
- Cardiac glycosides: Risk of synergistic arrhythmias; use with extreme caution and close ECG monitoring 2
- Calcium channel blockers: Calcium administration may reduce therapeutic response 2
By following this evidence-based approach to calcium gluconate administration, you can effectively manage severe symptomatic hypocalcemia while minimizing potential complications.