Calcium Gluconate Administration Rate
For bolus administration, calcium gluconate should NOT exceed 200 mg/minute in adults or 100 mg/minute in pediatric patients, with most routine infusions given over 30-60 minutes. 1
Maximum Infusion Rates by Age
Adults
- Maximum bolus rate: 200 mg/minute 1
- Standard infusion: 30-60 minutes for most indications 2, 3
- For routine hypocalcemia: infuse 50-100 mg/kg over 30-60 minutes 3, 4
Pediatric Patients (Including Neonates)
- Maximum bolus rate: 100 mg/minute 1
- Standard infusion: 30-60 minutes 2, 3
- Dose of 60 mg/kg infused over 30-60 minutes for mild hypocalcemia 3
Emergency Situations Requiring Faster Administration
Cardiac Arrest
- Calcium can be given by slow push with careful monitoring 3
- Note: The American Heart Association prefers calcium chloride over calcium gluconate in cardiac arrest due to more rapid increase in ionized calcium 2, 4
Calcium Channel Blocker Toxicity
- 0.6 mL/kg of 10% calcium gluconate (0.3 mEq/kg) IV over 5-10 minutes, followed by continuous infusion of 0.3 mEq/kg per hour 2, 4
- Alternative: 30-60 mL (3-6 grams) of 10% calcium gluconate IV every 10-20 minutes 3, 4
Beta-Blocker Overdose with Refractory Shock
- 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 2, 4
Critical Safety Monitoring
Continuous ECG monitoring is mandatory during administration, especially in patients receiving cardiac glycosides or with hyperkalemia 3, 4, 1
Stop Infusion Immediately If:
- Symptomatic bradycardia occurs 3
- Heart rate decreases by 10 beats per minute 3
- Any cardiac arrhythmias develop 1
Administration Technique
Dilution Requirements
- For bolus: Dilute to concentration of 10-50 mg/mL in 5% dextrose or normal saline 1
- For continuous infusion: Dilute to concentration of 5.8-10 mg/mL 1
Route Considerations
- Administer through a central venous catheter when possible to prevent severe skin and soft tissue injury from extravasation 2, 3
- Calcium gluconate is preferred over calcium chloride for peripheral administration due to less tissue irritation 3, 4
Common Pitfalls to Avoid
Rapid administration causes hypotension, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest 1
- Never mix with bicarbonate or phosphate-containing fluids (precipitation will occur) 3, 4, 1
- Do not mix with vasoactive amines 3, 4
- Never administer through the same line as sodium bicarbonate 3, 4
- Avoid concomitant use with cardiac glycosides due to increased risk of digoxin toxicity and arrhythmias 1