Can calcium gluconate (Calcium Gluconate) 10 milliliters (mL) be administered undiluted in the treatment of hyperkalemia?

From the Guidelines

No, calcium gluconate 10 ml should not be given undiluted in hyperkalemia. The standard administration requires diluting 10 ml of 10% calcium gluconate in 100 ml of 5% dextrose or normal saline and infusing it slowly over 5-10 minutes, as rapid undiluted administration can cause serious adverse effects including hypotension, bradycardia, cardiac arrhythmias, and even cardiac arrest 1.

Key Considerations

• Calcium gluconate works in hyperkalemia by stabilizing cardiac cell membranes against the effects of elevated potassium, providing temporary protection while other treatments work to lower potassium levels 1.
• This membrane-stabilizing effect typically begins within minutes but only lasts 30-60 minutes, so concurrent treatments to remove excess potassium from the body are necessary 1.
• Always administer through a large vein with cardiac monitoring in place, and never mix calcium gluconate with bicarbonate solutions as precipitation can occur 1.

Administration Guidelines

• Dilute 10 ml of 10% calcium gluconate in 100 ml of 5% dextrose or normal saline.
• Infuse slowly over 5-10 minutes.
• Monitor cardiac function and adjust administration as needed.

Treatment of Hyperkalemia

• Treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis 1.
• The choice of treatment depends on the severity of hyperkalemia, the presence of ECG changes, and the patient's underlying medical conditions.

From the FDA Drug Label

2 DOSAGE & ADMINISTRATION 2.1 Important Administration Instructions Calcium Gluconate Injection contains 100 mg of calcium gluconate per mL which contains 9.3 mg (i.e., 0.465 mEq) of elemental calcium. Dilute Calcium Gluconate Injection prior to use in 5% dextrose or normal saline and assess for potential drug or IV fluid incompatibilities [see Dosage and Administration (2. 5)].

For bolus intravenous administration: Dilute the dose [see Dosage and Administration (2. 2)] of Calcium Gluconate Injection in 5% dextrose or normal saline to a concentration of 10-50 mg/mL prior to administration.

The answer is no, calcium gluconate 10 milliliters (mL) should not be administered undiluted in the treatment of hyperkalemia.

• The label instructs to dilute Calcium Gluconate Injection prior to use in 5% dextrose or normal saline.
• The recommended concentration for bolus administration is 10-50 mg/mL, which requires dilution of the 100 mg/mL solution 2.

From the Research

Administration of Calcium Gluconate in Hyperkalemia

• Calcium gluconate can be administered undiluted in the treatment of hyperkalemia, as stated in the study 3, where it is recommended to provide 10 mL of 10% calcium gluconate intravenously for membrane stabilization, unless the patient is in cardiac arrest.
• The effectiveness of calcium gluconate in treating hyperkalemia has been evaluated in several studies, including 4, which found that IV calcium gluconate therapy was effective in main rhythm ECG disorders due to hyperkalemia, but not in nonrhythm ECG disorders.
• Other studies, such as 5 and 6, also discuss the use of calcium gluconate in the treatment of hyperkalemia, highlighting its role in stabilizing cardiac membranes and reducing the risk of fatal dysrhythmias.
• However, the mechanisms underlying the beneficial effects of calcium treatment for hyperkalemia are not fully understood, and research suggests that it may not be due to "membrane stabilization" as previously thought, but rather to Ca2+-dependent propagation, as suggested in study 7.

Dosage and Administration

• The recommended dosage of calcium gluconate is 10 mL of 10% solution, as stated in study 3.
• It is essential to note that the administration of calcium gluconate should be guided by the patient's clinical condition and electrocardiogram (ECG) findings, as well as their renal function and other underlying medical conditions, as discussed in studies 4 and 6.

Clinical Considerations

• Hyperkalemia is a life-threatening condition that requires prompt treatment, and calcium gluconate is one of the medications used to stabilize cardiac membranes and reduce the risk of fatal dysrhythmias, as highlighted in studies 3, 5, and 6.
• The treatment of hyperkalemia should be individualized, taking into account the patient's underlying medical conditions, renal function, and other factors, as discussed in studies 4 and 7.