Calcium Gluconate Infusion: Dosage and Dilution
Standard Dosing and Administration
For acute symptomatic hypocalcemia in adults, administer 1-3 grams (10-30 mL of 10% calcium gluconate) intravenously over 10 minutes, followed by a continuous infusion of 5-15 mg/kg/hour (0.5-1.5 grams/hour in a 100 kg adult). 1
Bolus Administration
- Dilution: Dilute calcium gluconate in 5% dextrose or normal saline to a concentration of 10-50 mg/mL prior to administration 1
- Rate: Do NOT exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients (including neonates) 1
- Monitoring: Continuous ECG and vital sign monitoring during bolus administration is mandatory 1
Continuous Infusion
- Dilution: Dilute to a concentration of 5.8-10 mg/mL in 5% dextrose or normal saline 1
- Standard regimen: 100 mL of 10% calcium gluconate (10 grams total) diluted in 1 liter of normal saline or 5% dextrose, infused at 50-100 mL/hour 2
- Monitoring frequency: Measure serum calcium every 1-4 hours during continuous infusion and every 4-6 hours during intermittent infusions 1
Pediatric Dosing
For pediatric patients with acute symptomatic hypocalcemia, administer 60 mg/kg of calcium gluconate intravenously over 30-60 minutes. 3
- Maximum infusion rate: Do not exceed 100 mg/minute in pediatric patients 1
- Preferred access: Central venous catheter is strongly preferred to avoid extravasation injury 3
Special Clinical Situations
Calcium Channel Blocker Toxicity
For CCB poisoning with hemodynamic instability, administer 30-60 mL (3-6 grams) of 10% calcium gluconate IV every 10-20 minutes, or as a continuous infusion at 0.6-1.2 mL/kg/hour (0.06-0.12 g/kg/hour). 4
- This dosing is based on expert consensus from the Society of Critical Care Medicine 4
- Calcium gluconate is preferred over calcium chloride for peripheral administration to minimize vein irritation 4
- Continuous ECG monitoring is essential during administration 4
Beta-Blocker Overdose
- Dose: 0.6 mL/kg of 10% calcium gluconate (or 0.2 mL/kg of 10% calcium chloride) IV over 5-10 minutes 5, 3
- Consider only when shock is refractory to other measures 5
Critical Administration Precautions
Vascular Access
Always use a secure intravenous line—preferably central venous access—to avoid calcinosis cutis and tissue necrosis from extravasation. 1
- Calcium gluconate causes less peripheral vein irritation than calcium chloride but can still cause severe tissue injury if extravasated 3
Drug Incompatibilities
Never mix calcium gluconate with the following: 1
- Ceftriaxone: Absolutely contraindicated in neonates ≤28 days due to fatal precipitate formation; in older patients, flush lines thoroughly between administrations 1
- Bicarbonate or phosphate-containing fluids: Precipitation will occur 1
- Minocycline: Calcium complexes and inactivates minocycline 1
- Vasoactive amines: Do not mix in the same line 5
Cardiac Monitoring
- Stop injection immediately if symptomatic bradycardia occurs during administration 3, 1
- Patients receiving cardiac glycosides require especially vigilant ECG monitoring 3
Renal Impairment Adjustments
In patients with renal impairment, initiate at the lowest recommended dose and monitor serum calcium every 4 hours. 1
This conservative approach prevents hypercalcemia in patients with reduced calcium clearance 1
Practical Preparation Notes
Pharmacy Bulk Package
- Penetrate container closure only once with sterile transfer device 1
- Use only in ISO Class 5 environment (laminar flow hood) 1
- Complete all dispensing within 4 hours of puncture 1
- Each dispensed dose must be used immediately 1
Solution Inspection
- Solution should appear clear and colorless to slightly yellow 1
- Do not administer if particulate matter or discoloration is present 1
- Use diluted solution immediately after preparation 1
Calcium Salt Equivalency
Each 10 mL of 10% calcium gluconate contains 2.2 mmol (93 mg) of elemental calcium, which is approximately one-third the elemental calcium content of calcium chloride. 2