How to administer calcium gluconate in hypocalcemia?

Administration of Calcium Gluconate in Hypocalcemia

For hypocalcemia treatment, calcium gluconate should be administered intravenously via a secure IV line, diluted in 5% dextrose or normal saline, with a maximum infusion rate of 200 mg/minute in adults or 100 mg/minute in pediatric patients. 1

Preparation and Administration

Dilution Requirements

• Calcium gluconate contains 100 mg/mL with 9.3 mg (0.465 mEq) of elemental calcium per mL 1
• For bolus administration: Dilute to 10-50 mg/mL in 5% dextrose or normal saline 1
• For continuous infusion: Dilute to 5.8-10 mg/mL in 5% dextrose or normal saline 1

Administration Routes and Rates

• Administer via a secure intravenous line to avoid tissue necrosis and calcinosis cutis 1
• Central venous access is preferred, especially for continuous infusions 2
• Maximum infusion rates:
  • Adults: 200 mg/minute 1
  • Pediatric patients: 100 mg/minute 1
  • Standard continuous infusion rate: 1 g/hour 2

Dosing Guidelines

Adult Dosing

• Mild hypocalcemia (ionized calcium 1-1.12 mmol/L): 1-2 g calcium gluconate 3
• Moderate to severe hypocalcemia (ionized calcium <1 mmol/L): 4 g calcium gluconate 4
• 4 g calcium gluconate infusion achieves normal calcium levels in 95% of patients with moderate to severe hypocalcemia 4

Monitoring

• Monitor ionized calcium levels every 4-6 hours during intermittent infusions 1
• Monitor every 1-4 hours during continuous infusion 1
• Monitor vital signs and ECG during administration 1
• Calcium levels typically plateau approximately 10 hours after infusion 5

Important Precautions

Drug Incompatibilities

• Do not mix with:
  • Fluids containing bicarbonate or phosphate (precipitation may occur) 2, 1
  • Ceftriaxone (can form precipitates) 1
  • Minocycline (calcium complexes render it inactive) 1

Safety Considerations

• Stop infusion if symptomatic bradycardia occurs 2
• Calcium chloride (10%) 5-10 mL is preferred over calcium gluconate in cardiac arrest situations 6
• For peripheral administration, calcium gluconate is safer than calcium chloride 2
• Extravasation can cause severe tissue injury and necrosis 1

Special Situations

Cardiac Arrest

• In cardiac arrest associated with hyperkalemia or hypermagnesemia, calcium chloride is preferred due to faster onset of action 6, 2
• If calcium gluconate is used in cardiac arrest, administer by slow IV push 2

Renal Impairment

• Start at the lower end of the dosage range 1
• Monitor serum calcium levels more frequently (every 4 hours) 1

By following these guidelines for calcium gluconate administration in hypocalcemia, you can effectively restore calcium levels while minimizing the risk of adverse effects. The European guideline on management of major bleeding and coagulopathy following trauma recommends monitoring and maintaining ionized calcium levels within the normal range, especially during massive transfusion 6.