What is the maximum dose of Calcium gluconate (Calcium gluconate) Intravenous (IV) for adults and pediatric patients?

Maximum Dose for Calcium Gluconate IV

The maximum infusion rate for IV calcium gluconate is 200 mg/minute in adults and 100 mg/minute in pediatric patients, including neonates, with no absolute maximum total daily dose specified in FDA labeling, though dosing should be guided by serum calcium monitoring every 1-4 hours during continuous infusion. 1

Administration Rate Limits

For bolus intravenous administration:

• Adults: DO NOT exceed 200 mg/minute 1
• Pediatric patients (including neonates): DO NOT exceed 100 mg/minute 1
• Dilute to a concentration of 10-50 mg/mL prior to administration 1
• Continuous ECG monitoring is required during administration 1

For continuous intravenous infusion:

• Dilute to a concentration of 5.8-10 mg/mL 1
• No specific maximum rate is defined, but titrate based on serum calcium levels 1
• Monitor serum calcium every 1-4 hours during continuous infusion 1

Total Dose Considerations by Clinical Scenario

For acute symptomatic hypocalcemia:

• Adults: 1-2 grams (1,000-2,000 mg) IV over 30-60 minutes, which can be repeated as needed based on symptoms and calcium levels 2
• Pediatric patients: 50-100 mg/kg IV over 30-60 minutes 2
• Life-threatening arrhythmias: 100-200 mg/kg/dose via slow infusion with ECG monitoring 2

For hyperkalemia with cardiac manifestations:

• Adults: 15-30 mL of 10% calcium gluconate (1,500-3,000 mg) IV over 2-5 minutes 3
• Pediatric patients: 100-200 mg/kg/dose via slow infusion with ECG monitoring 3
• May repeat after 5-10 minutes if no ECG improvement observed 3

For calcium channel blocker toxicity:

• 30-60 mL (3,000-6,000 mg) of 10% calcium gluconate IV every 10-20 minutes 2
• Or continuous infusion at 0.6-1.2 mL/kg/hour (60-120 mg/kg/hour) 2

For emergency antidote stocking (per hospital):

• Recommended stock: 30 grams (30,000 mg) for treating one 100-kg patient over 24 hours 4

Critical Safety Monitoring

Stop infusion immediately if:

• Symptomatic bradycardia occurs 1
• Heart rate decreases by 10 beats per minute 2
• ECG shows new arrhythmias 1

Measure serum calcium:

• Every 4-6 hours during intermittent infusions 1
• Every 1-4 hours during continuous infusion 1
• Every 4 hours in patients with renal impairment 1

Special Population Dosing

Renal impairment:

• Initiate at the lowest dose of the recommended range 1
• Monitor serum calcium every 4 hours 1
• Aluminum content (up to 400 mcg/L) may accumulate with prolonged administration in impaired kidney function 1

Neonates and premature infants:

• Maximum rate: 100 mg/minute 1
• Particularly at risk for aluminum toxicity with prolonged administration 1
• Contraindicated with concurrent ceftriaxone in neonates ≤28 days 1

Critical Contraindications and Warnings

Absolute contraindications:

• Hypercalcemia 1
• Neonates ≤28 days receiving ceftriaxone 1

Avoid or use extreme caution:

• Patients on cardiac glycosides (digoxin) - hypercalcemia increases digoxin toxicity risk 1
• Rapid administration causes vasodilation, hypotension, bradycardia, cardiac arrhythmias, syncope, and cardiac arrest 1

Drug incompatibilities - never mix with:

• Ceftriaxone (can form fatal precipitates) 1
• Bicarbonate-containing fluids (precipitation occurs) 1
• Phosphate-containing fluids (precipitation occurs) 1
• Minocycline (calcium complexes and inactivates it) 1

Administration Route Requirements

• Administer via secure intravenous line to avoid calcinosis cutis and tissue necrosis 1
• Central venous access preferred for higher concentrations 2
• If extravasation occurs, immediately discontinue and treat - can cause tissue necrosis, ulceration, and secondary infection 1
• Calcium gluconate is preferred over calcium chloride for peripheral administration due to less tissue irritation 2