Maximum Concentration of Calcium Gluconate for Peripheral Administration in Neonates and Pediatrics
For peripheral administration, calcium gluconate should be diluted to a concentration of 10-50 mg/mL (1-5%) in neonates and pediatric patients to avoid tissue damage and extravasation injuries. 1, 2
Administration Guidelines
Concentration Limits
- Neonates and infants: 10-50 mg/mL (1-5%) concentration when administered peripherally
- Older children: 10-50 mg/mL (1-5%) concentration when administered peripherally
Administration Route Considerations
- Central venous access is preferred for calcium administration whenever possible 1
- Peripheral administration carries significant risk of extravasation and tissue injury
- When peripheral administration is unavoidable, proper dilution is critical
Infusion Rates and Safety Precautions
Maximum Infusion Rates
Dilution Requirements
- Bolus administration: Dilute to 10-50 mg/mL in 5% dextrose or normal saline 2
- Continuous infusion: Dilute to 5.8-10 mg/mL in 5% dextrose or normal saline 2
Clinical Considerations and Precautions
Risks of Peripheral Administration
- Calcium gluconate extravasation through peripheral IV lines can cause severe skin and soft tissue injury 1
- Calcinosis cutis and tissue necrosis are serious complications of improper administration 2
Monitoring Requirements
- Monitor heart rate during administration
- Stop injection if symptomatic bradycardia occurs 1
- For continuous infusions, monitor serum calcium levels every 1-4 hours 2
Special Considerations for Neonates
Dosing Guidelines
- For hypocalcemia in neonates: 10-20 mg/kg (1-2 mL/kg of 10% calcium gluconate) given as slow IV infusion 3
- For maintenance therapy: 40-80 mg/kg/day of elemental calcium for asymptomatic newborns 3
Compatibility Issues
- Do not mix calcium gluconate with:
Alternative Calcium Preparations
- Calcium chloride provides more rapid increase in ionized calcium than calcium gluconate and may be preferred for critically ill children 1
- Calcium chloride dose: 20 mg/kg (0.2 mL/kg for 10% CaCl₂) 1
- Calcium gluconate dose: 60 mg/kg when calcium chloride is not available 1
Remember that calcium administration through a central venous catheter is always preferred over peripheral administration due to the significant risk of tissue damage with peripheral calcium infusion.