What is calcium gluconate used for?

Uses of Calcium Gluconate

Calcium gluconate is primarily used for the treatment of acute symptomatic hypocalcemia in both pediatric and adult patients. 1

Primary Clinical Indications

1. Hypocalcemia Treatment

• Symptomatic hypocalcemia: First-line treatment for patients with low serum calcium levels causing symptoms 1
• Post-parathyroidectomy: For patients who develop hypocalcemia after parathyroid surgery, calcium gluconate infusion should be initiated at 1-2 mg elemental calcium per kilogram body weight per hour when ionized calcium falls below normal (<0.9 mmol/L) 2
• Preterm infants: Effective in raising total and ionized serum calcium and decreasing clinical signs of hypocalcemia in preterm infants at doses of 100 mg/kg 3

2. Hyperkalemia Management

• Used to treat life-threatening arrhythmias associated with hyperkalemia
• Administered via slow infusion with ECG monitoring at doses of 100-200 mg/kg/dose in pediatric patients 2
• Stabilizes cardiac cell membranes, reducing excitability and protecting against arrhythmias

3. Hypermagnesemia Treatment

• Calcium gluconate (10% solution, 15-30 mL IV over 2-5 minutes) may be considered during cardiac arrest associated with hypermagnesemia 2
• Counteracts the cardiac effects of excess magnesium

4. Calcium Channel Blocker Toxicity

• Used as an antidote in calcium channel blocker overdose
• Helps restore cardiac contractility by competing with the channel blockers 2

Dosing Considerations

Elemental Calcium Content

• 10 mL of 10% calcium gluconate contains 90 mg of elemental calcium 2
• Calcium chloride provides more elemental calcium (270 mg per 10 mL of 10% solution) and may be preferred in critically ill patients 2

Administration Routes and Protocols

• IV administration: Most common for acute situations
  • For mild hypocalcemia (iCa 1-1.12 mmol/L): 1-2 g IV calcium gluconate is effective in 79% of cases 4
  • For moderate to severe hypocalcemia (iCa <1 mmol/L): 2-4 g IV calcium gluconate, though only effective in 38% of cases 4
  • Typical infusion rate: 1 g/hour 4

Special Considerations

Hepatic Function

• Calcium gluconate is as effective as calcium chloride in treating ionic hypocalcemia even in the absence of hepatic function 5
• Does not require hepatic metabolism for the release of ionized calcium

Cardiovascular Effects

• May increase arterial pressure primarily through peripheral vasoconstriction 6
• Should be used cautiously in patients with coronary artery disease as it may not improve coronary perfusion despite increasing blood pressure 6

Safety Precautions

• Administration through a central venous catheter is preferred
• Extravasation through a peripheral IV line may cause severe skin and soft tissue injury 2
• Should not be administered through the same line as sodium bicarbonate 2
• Monitor ECG during administration, especially in cardiac patients

Monitoring

• Regular measurement of ionized calcium levels is recommended during treatment
• For post-parathyroidectomy patients, monitor ionized calcium every 4-6 hours for the first 48-72 hours 2
• ECG monitoring is essential when administering calcium for cardiac indications 2

Remember that while calcium gluconate is generally safer for peripheral administration than calcium chloride, it contains less elemental calcium and may be less effective in emergency situations requiring rapid calcium replacement.