Calcium Gluconate IV Infusion Rate
For bolus administration, calcium gluconate should NOT exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients, and for continuous infusion, it should be administered over 30-60 minutes for most indications. 1
Maximum Infusion Rates by Administration Method
Bolus/Push Administration
- Adults: Maximum rate of 200 mg/minute 1
- Pediatric patients (including neonates): Maximum rate of 100 mg/minute 1
- For emergency cardiac situations, administer over 2-5 minutes with continuous ECG monitoring 2
- In calcium channel blocker toxicity, the initial dose should be given over 5-10 minutes 3
Standard Infusion for Hypocalcemia
- Recommended duration: 30-60 minutes for most clinical indications 4, 3
- This applies to the standard pediatric dose of 60 mg/kg 4
- Dilute to a concentration of 10-50 mg/mL for bolus administration or 5.8-10 mg/mL for continuous infusion 1
Continuous Infusion Protocols
- For calcium channel blocker toxicity: 0.6-1.2 mL/kg/hour of 10% calcium gluconate (0.06-0.12 g/kg/hour) 4
- For therapeutic plasma exchange: 1.6 g/hour appears optimal for preventing hypocalcemic reactions 5
- For post-parathyroidectomy management: Start at 4.5 mL/hour of 10% solution, titrate up to 9.0 mL/hour based on calcium levels 6
Critical Monitoring Requirements
During Administration
- Continuous ECG monitoring is essential, particularly in patients on cardiac glycosides or with hyperkalemia 4, 3
- Stop infusion immediately if symptomatic bradycardia occurs or heart rate decreases by 10 beats per minute 7, 4
- Monitor vital signs continuously during bolus administration 1
Laboratory Monitoring
- Measure serum calcium every 4-6 hours during intermittent infusions 1
- Measure serum calcium every 1-4 hours during continuous infusion 1
- Monitor ionized calcium levels to avoid hypercalcemia (>2× upper limit of normal) 3
Important Safety Considerations
Route and Access
- Central venous catheter is strongly preferred to prevent severe skin and soft tissue injury from extravasation 4, 2, 3
- Calcium gluconate is preferred over calcium chloride for peripheral administration due to less tissue irritation 4
- Ensure secure IV access before administration to avoid calcinosis cutis and tissue necrosis 1
Common Pitfalls to Avoid
- Never mix with ceftriaxone - can form fatal precipitates, especially contraindicated in neonates ≤28 days 1
- Do not mix with bicarbonate or phosphate-containing fluids - precipitation will occur 1
- Do not mix with minocycline - calcium complexes and inactivates it 1
- Avoid rapid infusion - can cause cardiac arrhythmias and symptomatic bradycardia 7, 4
Preparation Requirements
- Dilute in 5% dextrose or normal saline before administration 1
- Inspect for clarity and absence of particulate matter before use 1
- Use diluted solution immediately after preparation 1