From the Guidelines
For hyperkalemia, the recommended dose of calcium gluconate is 15 to 30 mL of a 10% solution administered intravenously over 2 to 5 minutes, as suggested by the 2010 American Heart Association guidelines 1. However, more recent evidence from 2021 suggests that the dose can be repeated if no effect is observed within 5 to 10 minutes 1. The administration of calcium gluconate works rapidly by stabilizing cardiac cell membranes, protecting the heart from the effects of hyperkalemia, though it does not actually lower potassium levels. Some key points to consider when administering calcium gluconate include:
- Monitoring the patient's ECG continuously
- Watching for signs of hypercalcemia such as nausea or bradycardia
- Using caution in patients taking digoxin as calcium can potentiate digoxin toxicity
- Ensuring IV access is secure as extravasation can cause tissue necrosis. It is also important to note that calcium gluconate is a temporary measure that provides protection for approximately 30-60 minutes while other treatments that actually remove potassium from the body (such as insulin with glucose, sodium bicarbonate, beta-agonists, or diuretics) take effect 1.
From the Research
Calcium Gluconate Dose for Hyperkalemia
- The dose of calcium gluconate for hyperkalemia is 10% dosed 10 mL intravenously, as stated in the study 2.
- This dose is recommended for membrane stabilization, unless the patient is in cardiac arrest, in which case 10 mL calcium chloride is warranted 2.
- The effectiveness of IV Calcium gluconate in the treatment of hyperkalemia has been evaluated in a prospective observational study, which found that it was effective in main rhythm ECG disorders due to hyperkalemia, but not in nonrhythm ECG disorders 3.
- Calcium gluconate is often used in combination with other treatments, such as insulin and glucose, beta-agonists, and dialysis, to manage hyperkalemia 4, 2, 5, 6.
Treatment of Hyperkalemia
- Hyperkalemia is a common electrolyte disorder that can result in morbidity and mortality if not managed appropriately 4, 2.
- Treatment includes measures to stabilize cardiac membranes, shift potassium from extracellular to intracellular stores, and promote potassium excretion 2.
- Other treatments for hyperkalemia include glucose and insulin, bicarbonate, beta-2 agonists, hyperventilation, and dialysis 4, 2, 5, 6.
- New medications, such as patiromer and sodium zirconium cyclosilicate, have been developed to promote gastrointestinal potassium excretion and hold promise for the treatment of hyperkalemia 4, 2.