How is calcium gluconate administered?

From the Guidelines

Calcium gluconate should be administered intravenously at a dose of 30-60 mL (3-6 g) every 10-20 minutes or as an infusion at 0.6-1.2 mL/kg/hr (0.06-0.12 g/kg/hr) to minimize peripheral vein irritation. This recommendation is based on the expert consensus guidelines for the management of calcium channel blocker poisoning in adults, as published in the Critical Care Medicine journal in 2017 1.

Administration Details

When administering calcium gluconate, it is essential to consider the clinical situation and the desired effect. The dose regimen may vary depending on the patient's condition and response to treatment.

• The administration of calcium gluconate via a secure peripheral or central venous line is crucial to minimize the risk of complications.
• The use of 10% calcium gluconate solution is preferred over calcium chloride to reduce the risk of tissue irritation and vein damage.
• Close monitoring of cardiac function and serum calcium levels is necessary during administration to adjust the dose and infusion rate as needed.

Clinical Considerations

The administration of calcium gluconate is a critical aspect of managing calcium channel blocker poisoning, as it can help improve contractility and blood pressure.

• The treatment should be tailored to the individual patient's clinical condition, taking into account the severity of symptoms and the presence of any comorbidities.
• The use of high-dose insulin in conjunction with calcium gluconate may be considered in certain cases, as it has been shown to improve contractility, blood pressure, and potentially increase survival 1.

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)]. Inspect Calcium Gluconate Injection visually prior to administration. The solution should appear clear and colorless to slightly yellow. Do not administer if there is particulate matter or discoloration. Use the diluted solution immediately after preparation Administer Calcium Gluconate Injection intravenously via a secure intravenous line to avoid calcinosis cutis and tissue necrosis [see Warnings and Precautions ( 5-5.3)]. Administer Calcium Gluconate Injection by bolus administration or continuous infusion: 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. Administer the dose slowly and DO NOT exceed an infusion rate of 200 mg/minute in adults or 100 mg/minute in pediatric patients, including neonates. Monitor patients, vitals and electrocardiograph (ECG) during administration [see Warnings and Precautions ( 5-5. 4)]. For continuous intravenous infusion: Dilute Calcium Gluconate Injection in 5% dextrose or normal saline to a concentration of 5.8-10 mg/mL prior to administration. Administer at the rate recommended in Table 1 [see Dosage and Administration (2.2)] and monitor patients, vitals, calcium and ECG during the infusion [see Warnings and Precautions ( 5-5. 4)].

Administration Methods:

• Intravenous bolus administration: Dilute to 10-50 mg/mL and administer slowly, not exceeding 200 mg/minute in adults or 100 mg/minute in pediatric patients.
• Continuous intravenous infusion: Dilute to 5.8-10 mg/mL and administer at the recommended rate, monitoring patients and vitals during infusion. Calcium gluconate is administered intravenously via a secure intravenous line, using either bolus administration or continuous infusion, and should be diluted in 5% dextrose or normal saline prior to administration 2.

From the Research

Administration of Calcium Gluconate

• Calcium gluconate can be administered intravenously (IV) to treat hypocalcemia, with the dose and rate of infusion varying depending on the severity of the condition 3, 4, 5, 6, 7.
• For mild hypocalcemia, a dose of 1-2 g of IV calcium gluconate may be effective, while for moderate to severe hypocalcemia, a dose of 2-4 g or more may be required 3, 4, 5.
• The calcium gluconate can be infused at a rate of 1 g/h in a small-volume admixture, with serum ionized calcium concentrations monitored to assess the efficacy of the therapy 3, 4, 5.
• In some cases, a higher dose of calcium gluconate, such as 4 g, may be infused at a rate of 1 g/h to achieve a significant increase in serum ionized calcium concentrations 4, 5.
• For severe hypocalcemia, an initial dose of 10-20 mL of 10% calcium gluconate can be administered IV over 10 minutes, followed by a calcium gluconate infusion at a rate of 50-100 mL/h, with the rate titrated to achieve normocalcaemia 6.
• Calcium gluconate can also be infused at a rate of 1.0 or 1.6 g/h to prevent hypocalcemic reactions during therapeutic plasma exchange, with the higher rate appearing to be more effective in stabilizing plasma ionized calcium concentrations 7.

Key Considerations

• The dose and rate of calcium gluconate infusion should be individualized based on the patient's condition and response to therapy 3, 4, 5, 6, 7.
• Serum ionized calcium concentrations should be monitored regularly to assess the efficacy of the therapy and adjust the dose and rate of infusion as needed 3, 4, 5, 6, 7.
• Calcium gluconate can be administered in conjunction with other treatments, such as specialized nutrition support, to manage hypocalcemia in critically ill patients 3, 4, 5.