What is the recommended dose, rate, and dilution of calcium gluconate for treating hyperkalemia?

Calcium Gluconate Administration for Hyperkalemia

For hyperkalemia treatment, administer 10% calcium gluconate 15-30 mL IV over 2-5 minutes for adults, or 60 mg/kg for children, to stabilize cardiac membranes. 1

Adult Dosing and Administration

• 10% calcium gluconate: 15-30 mL (1.5-3 grams) IV over 2-5 minutes for cardiac membrane stabilization 1
• For cardiac arrest due to hyperkalemia, administer as a slow IV push; for other indications, infuse over 30-60 minutes 1
• Calcium gluconate is preferred over calcium chloride when using peripheral IV access due to lower risk of tissue injury from extravasation 2

Pediatric Dosing and Administration

• Calcium gluconate dose: 60 mg/kg IV 1
• Administer by slow push for cardiac arrest; infuse over 30-60 minutes for other indications 1
• Monitor heart rate during administration and repeat doses as necessary for desired clinical effect 1

Dilution Guidelines

• No specific dilution is required for 10% calcium gluconate solution 1
• Administration through a central venous catheter is preferred when available 1
• If using peripheral IV, ensure proper placement as extravasation can cause severe skin and soft tissue injury 1

Monitoring and Precautions

• Monitor ECG during administration; stop injection if symptomatic bradycardia occurs 1
• Calcium gluconate primarily stabilizes cardiac membranes but has minimal effect on reducing serum potassium levels 1, 3
• Most effective for treating main cardiac rhythm disorders due to hyperkalemia rather than non-rhythm ECG changes 3
• Do not mix calcium gluconate with sodium bicarbonate as precipitation may occur 1

Complete Hyperkalemia Management Algorithm

1. First: Cardiac membrane stabilization

   • Calcium gluconate 10%: 15-30 mL IV over 2-5 minutes (adults) or 60 mg/kg (children) 1

2. Second: Shift potassium into cells

   • Insulin and glucose: 10 units regular insulin with 25g glucose (50 mL of D50W) IV over 15-30 minutes 1
   • Alternative insulin dosing: 0.1 units/kg insulin with 400 mg/kg glucose (ratio of 1 unit insulin for every 4g glucose) 1
   • Nebulized albuterol: 10-20 mg nebulized over 15 minutes 1
   • Sodium bicarbonate: 50 mEq IV over 5 minutes (especially if metabolic acidosis present) 1

3. Third: Remove potassium from body

   • Diuresis: furosemide 40-80 mg IV 1
   • Potassium-binding resins: 15-50g orally or per rectum 1
   • Dialysis for severe cases or when other measures are ineffective 1

Important Clinical Pearls

• Calcium gluconate administration results in a less rapid increase in ionized calcium concentration than calcium chloride but is safer for peripheral administration 1
• Calcium chloride (10%): 5-10 mL (500-1000 mg) IV may be used as an alternative, especially in cardiac arrest situations 1
• The effect of calcium on cardiac membrane stabilization begins within 1-3 minutes but is temporary and may need to be repeated if ECG changes persist 1, 2
• Recent evidence suggests calcium gluconate may be more effective for main rhythm disorders than for non-rhythm ECG changes due to hyperkalemia 3
• Combination therapy with insulin/glucose and nebulized beta-agonists may be more effective than either treatment alone 4, 5