Contraindications of Calcium Gluconate
Calcium gluconate is contraindicated in patients with hypercalcemia and in neonates (28 days of age or younger) receiving ceftriaxone. 1
Absolute Contraindications
- Hypercalcemia: Calcium gluconate should not be administered to patients with elevated calcium levels as it may worsen this condition 1
- Neonates (≤28 days) receiving ceftriaxone: Concurrent use can lead to fatal outcomes due to crystalline material formation in lungs and kidneys 1
Relative Contraindications and Precautions
Medication Interactions
- Cardiac glycosides: Calcium administration may precipitate cardiac arrhythmias in patients on digoxin or other cardiac glycosides; if concomitant therapy is necessary, administer calcium slowly in small amounts with close ECG monitoring 1
- Ceftriaxone in patients >28 days: While not absolutely contraindicated in older patients, ceftriaxone and calcium should not be administered simultaneously via Y-site; they may be given sequentially if infusion lines are thoroughly flushed between administrations 1
Administration Concerns
- Extravasation risk: Intravenous administration and local trauma may result in calcinosis cutis, tissue necrosis, ulceration, and secondary infection 1
- Rapid administration: Can cause vasodilation, hypotension, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest 1
- Elevated phosphate or bicarbonate levels: Calcium gluconate is not physically compatible with fluids containing phosphate or bicarbonate as precipitation may result 1
Patient-Specific Considerations
- Elevated calcium levels: In patients with hyperphosphatemia and elevated calcium levels, calcium carbonate should not be used as a phosphate binder 2
- Renal impairment: Requires careful dosing, starting at the lowest recommended dose with frequent monitoring of serum calcium levels 1
- Aluminum toxicity risk: Calcium gluconate contains aluminum that may be toxic, particularly with prolonged use 1
Special Considerations
Tumor Lysis Syndrome
- In patients with tumor lysis syndrome and hyperphosphatemia, calcium administration requires caution due to increased risk of calcium phosphate precipitation in tissues and consequential obstructive uropathy 2
Hypocalcemia Management
- For symptomatic hypocalcemia requiring calcium gluconate, ECG monitoring is recommended during administration, especially in patients with hyperkalemia 3
- In cardiac arrest situations, calcium chloride is preferred over calcium gluconate due to its more rapid increase in ionized calcium concentration 3
Administration Route
- Central venous catheter administration is recommended to prevent severe skin and soft tissue injury from extravasation through a peripheral IV line 3
By understanding these contraindications and taking appropriate precautions, clinicians can safely administer calcium gluconate when indicated while minimizing potential adverse effects.