What is the recommended dose of calcium gluconate (Calcium Gluconate) for treating hypocalcemia in children?

Calcium Gluconate Dosing in Children

For treating hypocalcemia in children, calcium gluconate should be administered at a dose of 60 mg/kg intravenously. 1

Dosing Guidelines by Age and Clinical Scenario

Intravenous Administration

• Symptomatic hypocalcemia (tetany, seizures):

  • Acute treatment: 10-20 mg/kg of elemental calcium (1-2 mL/kg of 10% calcium gluconate) as slow IV infusion 2
  • This equals approximately 100-200 mg/kg of calcium gluconate

• Asymptomatic hypocalcemia:

  • Elementary calcium replacement: 40-80 mg/kg/day 2
  • As calcium gluconate contains 9.3 mg (0.465 mEq) of elemental calcium per 100 mg 3, this translates to approximately 430-860 mg/kg/day of calcium gluconate

Neonates and Infants

• Neonates (≤1 month):

  • Initial bolus: 100-200 mg/kg calcium gluconate 3
  • Subsequent doses: 100-200 mg/kg every 6 hours if needed 3
  • Continuous infusion: Initiate at 17-33 mg/kg/hour 3

• Infants and Children (>1 month to <17 years):

  • Initial bolus: 29-60 mg/kg calcium gluconate 3
  • Subsequent doses: 29-60 mg/kg every 6 hours if needed 3
  • Continuous infusion: Initiate at 8-13 mg/kg/hour 3

Administration Techniques

Important Administration Guidelines

1. Dilution: Dilute calcium gluconate prior to use in 5% dextrose or normal saline 3
2. Rate of administration:
   • Do not exceed 100 mg/minute in pediatric patients 3
   • For continuous infusions, use concentration of 5.8-10 mg/mL 3
3. Monitoring:
   • Monitor serum calcium every 4-6 hours during intermittent infusions 3
   • Monitor every 1-4 hours during continuous infusion 3
   • Stop injection if symptomatic bradycardia occurs 1

Route of Administration

• Preferred route: Administration through a central venous catheter is preferred 1
• Caution with peripheral IV: Extravasation through a peripheral IV line may cause severe skin and soft tissue injury 1

Clinical Considerations and Precautions

Indications for Treatment

• Documented hypocalcemia
• Hyperkalemia
• Hypermagnesemia
• Calcium channel blocker toxicity 1

Monitoring Parameters

• Serum calcium levels (total and ionized)
• Heart rate and ECG during administration
• Signs of hypocalcemia resolution (if symptomatic)

Efficacy Evidence

• A double-blind study showed that a single dose of calcium gluconate (100 mg/kg) in hypocalcemic preterm infants effectively raised both total and ionized serum calcium and decreased clinical signs of hypocalcemia 4

Potential Adverse Effects

• Gastrointestinal complaints 5
• Risk of calcium phosphate precipitation if phosphate levels are high 1
• Constipation (calcium carbonate has more constipating effects than calcium gluconate) 6

Special Considerations

Renal Impairment

• For patients with renal impairment, initiate at the lowest dose of the recommended range and monitor serum calcium levels every 4 hours 3

Drug Incompatibilities

• Do not mix with ceftriaxone (risk of precipitate formation) 3
• Do not mix with fluids containing bicarbonate or phosphate 3
• Do not mix with minocycline injection 3
• Do not mix with vasoactive amines 1

By following these dosing guidelines and administration precautions, calcium gluconate can be safely and effectively used to treat hypocalcemia in pediatric patients while minimizing the risk of adverse effects.