What is the dose of calcium gluconate?

From the Guidelines

The recommended dose of calcium gluconate for hypocalcemia is 60 mg/kg, which may be substituted if calcium chloride is not available 1.

Key Considerations

• The dose of calcium gluconate varies by indication and route of administration.
• For cardiac resuscitation, calcium gluconate is recommended only in cases of documented hyperkalemia, hypocalcemia, hypermagnesemia, or calcium channel blocker toxicity.
• Calcium chloride administration results in a more rapid increase in ionized calcium concentration than calcium gluconate and is preferred for the critically ill child.
• Administration through a central venous catheter is preferred; extravasation through a peripheral IV line may cause severe skin and soft tissue injury.

Important Details

• The dose for children is 60 mg/kg, which is a substitution for calcium chloride if it is not available.
• Calcium gluconate works by directly increasing serum calcium levels, which is essential for nerve conduction, muscle contraction, blood coagulation, and many enzymatic processes.
• Side effects may include local irritation at injection sites, hypercalcemia symptoms (nausea, vomiting, constipation), and cardiac arrhythmias if administered too rapidly.
• Always monitor calcium levels during treatment and adjust dosing accordingly.

Clinical Application

• In clinical practice, it is essential to consider the indication, route of administration, and patient population when determining the dose of calcium gluconate.
• The medication should be administered slowly and with caution, and patients should be monitored closely for potential side effects.
• Consultation with a poison center or clinical toxicologist is strongly encouraged before use in cases of acute ingestion of selected toxic substances.

From the FDA Drug Label

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 Calcium Gluconate Injection should be individualized based on the severity of symptoms of hypocalcemia, serum calcium level, and acuity of onset.

• The dose depends on the severity of symptoms, serum calcium level, and acuity of onset of hypocalcemia.
• Table 1 provides specific dosing recommendations for different age groups, including neonates, pediatric, and adult patients 2.
• For renal impairment, initiate at the lowest dose of the recommended range and monitor serum calcium levels every 4 hours 2.

From the Research

Calcium Gluconate Dose

• The dose of calcium gluconate varies depending on the severity of hypocalcemia, with studies suggesting the following doses:
  • For mild hypocalcemia (ionized serum calcium [iCa] 1-1.12 mmol/L), 1-2 g of IV calcium gluconate may be effective 3
  • For moderate to severe hypocalcemia (iCa <1 mmol/L), 2-4 g of IV calcium gluconate may be necessary, although this dose may not always be effective 3
  • A study found that an infusion of 4 g of calcium gluconate was effective in increasing serum iCa in critically ill, adult, multiple-trauma patients with moderate to severe hypocalcemia 4
• The infusion rate of calcium gluconate also varies, with studies using rates of 1 g/h 3, 4 and 1.6 g/h 5
• The choice of calcium gluconate dose and infusion rate may depend on the individual patient's response to treatment, as well as the presence of other medical conditions or complications

Factors Influencing Calcium Gluconate Dose

• The severity of hypocalcemia is a key factor in determining the dose of calcium gluconate, with more severe cases requiring higher doses 3, 4
• The patient's weight and body composition may also influence the dose of calcium gluconate, with some studies normalizing the dose to body weight (mg/kg/d) 3
• The presence of other medical conditions, such as kidney disease or heart failure, may also affect the choice of calcium gluconate dose and infusion rate 6, 7

Clinical Considerations

• Calcium gluconate is often used in conjunction with other treatments, such as vitamin D supplementation, to manage hypocalcemia 7
• The use of calcium gluconate in patients with hypoparathyroidism may require careful monitoring and adjustment of the dose to avoid hypercalcemia 7
• The development of new therapies, such as recombinant human parathyroid hormone, may modify the management of chronic hypoparathyroidism in the future 7