Can calcium gluconate (Ca gluconate) be rapidly pushed intravenously (IV)?

Calcium Gluconate Administration: Safety Guidelines for IV Push

Calcium gluconate should not be rapidly pushed intravenously but rather administered slowly, with a maximum rate of 100 mg/minute in pediatric patients and 200 mg/minute in adults when rapid IV bolus is required. 1

Safety Concerns with Rapid Administration

• Rapid injection of calcium gluconate can cause serious adverse effects including vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest 1
• Administration through a central venous catheter is preferred as extravasation through a peripheral IV line may cause severe skin and soft tissue injury 2
• If rapid IV administration is necessary, ECG monitoring during administration is recommended 1

Proper Administration Guidelines

• For most indications, calcium gluconate should be infused over 30-60 minutes 2
• For cardiac arrest situations, calcium chloride is preferred over calcium gluconate due to more rapid increase in ionized calcium concentration 2
• When calcium gluconate must be used in emergency situations:
  • Dilute with 5% dextrose or normal saline 1
  • Infuse slowly at controlled rates 1
  • Monitor heart rate and stop injection if symptomatic bradycardia occurs 2

Special Considerations

• For treatment of calcium channel blocker toxicity, hypocalcemia, hypermagnesemia, or hyperkalemia during cardiac arrest, calcium can be given by slow push, but still with careful monitoring 2
• For treatment of hypocalcemia in non-emergent situations, 10-20 mL of 10% calcium gluconate should be administered in 50-100 mL of 5% dextrose over 10 minutes with ECG monitoring 3
• In patients with renal impairment, particularly premature neonates, there is risk of aluminum toxicity with repeated administration 1

Contraindications and Drug Interactions

• Concomitant use with cardiac glycosides increases risk of arrhythmias - if necessary, calcium gluconate should be given slowly in small amounts with close ECG monitoring 1
• Concomitant use with ceftriaxone is contraindicated in neonates (≤28 days) due to risk of fatal precipitates 1
• Do not administer simultaneously with ceftriaxone via Y-site in any age group 1

Dosing in Specific Situations

• For hypocalcemia treatment in adults: Initial dose of 10-20 mL of 10% calcium gluconate (1-2 g) in 50-100 mL of 5% dextrose over 10 minutes 3
• For maintenance infusion in hypocalcemia: Dilute 100 mL of 10% calcium gluconate in 1L of normal saline or 5% dextrose and infuse at 50-100 mL/h 3
• For pediatric patients with hypocalcemia, hyperkalemia, hypermagnesemia, or calcium channel blocker toxicity: 60 mg/kg administered slowly 2

Remember that calcium chloride provides more rapid increases in ionized calcium than calcium gluconate and is therefore preferred in critical emergency situations, particularly cardiac arrest 2.