Calcium Gluconate Administration Protocol
For patients requiring calcium supplementation, calcium gluconate should be administered at a dose of 0.3 mEq/kg (0.6 mL/kg of 10% calcium gluconate solution) IV over 5-10 minutes, followed by an infusion of 0.3 mEq/kg per hour with the rate titrated to achieve adequate hemodynamic response. 1
Dosing Guidelines
Adult Dosing
- For IV bolus administration: Dilute calcium gluconate to a concentration of 10-50 mg/mL in 5% dextrose or normal saline and administer at a rate not exceeding 200 mg/minute 2
- For continuous IV infusion: Dilute to a concentration of 5.8-10 mg/mL in 5% dextrose or normal saline 2
- For hypocalcemia treatment: 10-20 mL of 10% calcium gluconate (1-2 g) in 50-100 mL of 5% dextrose IV over 10 minutes, followed by infusion 3
- For maintenance therapy: Dilute 100 mL of 10% calcium gluconate in 1 L of normal saline or 5% dextrose and infuse at 50-100 mL/h 3
Pediatric Dosing
- For hypocalcemia, hyperkalemia, hypermagnesemia, or calcium channel blocker toxicity: 60 mg/kg administered slowly 4
- For symptomatic hypocalcemia (tetany, seizures): 50-100 mg/kg as a single dose, cautiously repeated if necessary 4
Administration Considerations
Route and Method
- Administer through a central venous catheter whenever possible to prevent severe skin and soft tissue injury from extravasation 4, 5
- For most indications, calcium gluconate should be infused over 30-60 minutes 4
- In cardiac arrest situations, calcium chloride is preferred over calcium gluconate due to its more rapid increase in ionized calcium concentration 4, 5
Monitoring
- ECG monitoring is recommended during calcium administration, especially in patients with hyperkalemia 4, 5
- Monitor serum calcium every 4-6 hours during intermittent infusions and every 1-4 hours during continuous infusion 2
- Monitor ionized calcium levels during infusion, avoiding severe hypercalcemia (ionized calcium levels greater than twice the upper limits of normal) 1
Special Considerations
Composition and Equivalence
- 10% calcium gluconate contains 9.3 mg (0.465 mEq) of elemental calcium per mL 2
- One 10-mL ampule of 10% calcium gluconate contains approximately 90 mg of elemental calcium 6
- Calcium gluconate contains 9% elemental calcium compared to calcium chloride which contains more elemental calcium 6
Clinical Scenarios
- For β-blocker or calcium channel blocker overdose with refractory shock: Administer 0.3 mEq/kg of calcium (0.6 mL/kg of 10% calcium gluconate) IV over 5-10 minutes, followed by infusion of 0.3 mEq/kg per hour 1
- For post-parathyroidectomy management: If ionized calcium falls below normal, initiate calcium gluconate infusion at 1-2 mg elemental calcium per kg body weight per hour 6
- For therapeutic plasma exchange: Infusion of calcium gluconate at 1.6 g/h appears more effective than 1.0 g/h in preventing hypocalcemic reactions 7
Precautions
- Do not mix calcium gluconate with ceftriaxone due to risk of precipitation 2
- In patients with hyperphosphatemia, use calcium with caution due to risk of calcium phosphate precipitation in tissues 5
- Stop calcium gluconate injection if symptomatic bradycardia occurs during administration 6
- For patients with renal impairment, initiate at the lowest dose of the recommended range and monitor serum calcium levels every 4 hours 2
Treatment Response
- Response to calcium therapy is highly variable between individuals 8
- For mild hypocalcemia (ionized calcium 1-1.12 mmol/L), 1-2 g of IV calcium gluconate is effective in normalizing calcium levels in approximately 79% of patients 8
- For moderate to severe hypocalcemia (ionized calcium <1 mmol/L), higher doses of 2-4 g may be required, though success rates are lower (approximately 38%) 8