From the Guidelines
The recommended intravenous (IV) calcium gluconate dose is 15 to 30 mL of a 10% solution administered over 2 to 5 minutes, as suggested for suspected hyperkalemia or hypermagnesemia in cardiac arrest situations 1. When considering the administration of IV calcium gluconate, it's crucial to weigh the potential benefits against the risks, particularly in the context of cardiac arrest. The dose of 15 to 30 mL of a 10% solution is specifically mentioned for scenarios where hyperkalemia or hypermagnesemia is suspected as the cause of cardiac arrest, according to the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Key points to consider when administering IV calcium gluconate include:
- Monitoring the patient's electrocardiogram, especially in digitalized patients, due to the potential for rapid administration to cause bradycardia or other arrhythmias.
- Checking serum calcium levels before and after administration to ensure the treatment is effective and to avoid hypercalcemia.
- Being aware that calcium gluconate is preferred over calcium chloride for peripheral administration because it causes less tissue irritation if extravasation occurs. The use of calcium gluconate in clinical practice extends beyond cardiac arrest scenarios, including the treatment of hypocalcemia, hyperkalemia, hypermagnesemia, and calcium channel blocker toxicity, by directly increasing serum calcium levels, which is essential for various bodily functions including nerve and muscle function, blood coagulation, and cardiac function.
From the FDA Drug Label
2 DOSAGE & ADMINISTRATION
2.1 Important Administration Instructions Calcium Gluconate Injection contains 100 mg of calcium gluconate per mL which contains 9.3 mg (i.e., 0.465 mEq) of elemental calcium.
2.2 Recommended Dosage Individualize the dose of Calcium Gluconate Injection within the recommended range depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia.
Table 1 provides dosing recommendations for Calcium Gluconate Injection in mg of calcium gluconate for neonates, pediatric and adult patients.
The recommended dose of IV calcium gluconate is individualized based on the severity of symptoms of hypocalcemia, serum calcium level, and acuity of onset. The dose is within the recommended range provided in Table 1 for neonates, pediatric, and adult patients 2.
- Key considerations:
- The dose should be diluted to a concentration of 10-50 mg/mL for bolus administration or 5.8-10 mg/mL for continuous infusion.
- The infusion rate should not exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients, including neonates.
- Serum calcium levels should be monitored every 4 to 6 hours during intermittent infusions and every 1 to 4 hours during continuous infusion.
From the Research
IV Calcium Gluconate Dose
The provided studies do not directly mention the specific dose of IV calcium gluconate. However, they discuss the importance of calcium in the body and the management of hypocalcemia.
- The study by 3 mentions that intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia.
- The study by 4 provides a comprehensive overview of calcium physiology and management of hypocalcemia, but does not specify the dose of IV calcium gluconate.
- The study by 5 discusses the role of calcium in the body and the diagnosis of hypocalcemia, but does not provide information on the dose of IV calcium gluconate.
- The study by 6 reviews the causes and treatment of disturbances of the serum concentration of calcium, but does not specify the dose of IV calcium gluconate.
- The study by 7 provides a physiology-based approach to understanding hypocalcemia, but does not mention the specific dose of IV calcium gluconate.
Management of Hypocalcemia
The management of hypocalcemia is discussed in several studies, including:
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 3.
- Intravenous calcium infusion is used to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 3.
- Recombinant human parathyroid hormone (rhPTH) has been approved for the treatment of hypoparathyroidism, and has the advantage of being effective for correcting serum calcium levels and reducing the daily requirements of calcium and active vitamin D supplements 3.