Calcium Gluconate Infusion Concentration
For continuous infusion, dilute calcium gluconate to a concentration of 5.8-10 mg/mL, and for bolus administration, use 10-50 mg/mL. 1
Standard Concentration Guidelines
The FDA-approved labeling provides clear concentration parameters based on administration method 1:
- Continuous infusion: Dilute to 5.8-10 mg/mL in 5% dextrose or normal saline 1
- Bolus administration: Dilute to 10-50 mg/mL in 5% dextrose or normal saline 1
Maximum Infusion Rates
Never exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients, including neonates. 1
These rate limits are critical to prevent cardiac arrhythmias and symptomatic bradycardia 2. Continuous ECG monitoring is mandatory during administration 2, 3.
Clinical Context-Specific Dosing
Calcium Channel Blocker Overdose
For hemodynamically unstable CCB poisoning, the Society of Critical Care Medicine recommends 4, 2:
- Bolus: 30-60 mL (3-6 g) of 10% calcium gluconate IV every 10-20 minutes
- Continuous infusion: 0.6-1.2 mL/kg/hour (0.06-0.12 g/kg/hour)
This translates to using the 10% solution (100 mg/mL) directly or diluted minimally for these emergency situations 4.
Hypocalcemia Treatment
For symptomatic hypocalcemia 3, 1:
- Administer 50-100 mg/kg IV as a single dose, infused slowly with ECG monitoring
- Pediatric dosing: 60 mg/kg infused over 30-60 minutes 2, 3
Critical Safety Considerations
Stop the infusion immediately if symptomatic bradycardia occurs or heart rate decreases by 10 beats per minute. 2
Administration Route
- Strongly prefer central venous access when available, as extravasation through peripheral IV lines causes severe skin and soft tissue injury (calcinosis cutis and tissue necrosis) 5, 3, 1
- Calcium gluconate is preferred over calcium chloride for peripheral administration due to less tissue irritation 2, 3
Monitoring Requirements
- Measure serum calcium every 4-6 hours during intermittent infusions 1
- Measure serum calcium every 1-4 hours during continuous infusion 1
- Continuous ECG monitoring is essential, especially in patients receiving cardiac glycosides 2, 3
Common Pitfalls to Avoid
Never mix calcium gluconate with ceftriaxone, bicarbonate-containing fluids, phosphate-containing fluids, or minocycline. 1 Precipitation or drug inactivation will occur.
Do not administer undiluted calcium gluconate. 1 The 100 mg/mL concentration in the vial must be diluted according to the administration method chosen.
For renal impairment, initiate at the lowest recommended dose and monitor serum calcium every 4 hours 1.