How to prepare calcium gluconate for hyperkalemia?

From the Guidelines

To prepare calcium gluconate for hyperkalemia, administer 15 to 30 mL of 10% calcium gluconate intravenously over 2 to 5 minutes in adults, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. This dose can be repeated after 5-10 minutes if ECG changes of hyperkalemia persist, according to the clinical management of hyperkalemia guidelines published in the Mayo Clinic Proceedings in 2021 1.

Key Considerations

• The administration of calcium gluconate should be done through a large peripheral vein or central line.
• When administering, monitor the patient's heart rate continuously, as rapid administration can cause bradycardia or cardiac arrest.
• Calcium gluconate works by stabilizing cardiac cell membranes, counteracting the effects of hyperkalemia on cardiac conduction within minutes, though this effect is temporary (lasting 30-60 minutes) and does not actually lower potassium levels.
• It's essential to note that calcium should be used cautiously in patients taking digoxin as it may potentiate digoxin toxicity.
• Additionally, calcium gluconate should not be mixed with bicarbonate solutions as precipitation may occur, as mentioned in the 2010 American Heart Association guidelines 1.

Important Details

• For pediatric patients, the dose is typically 100 mg/kg (1 mL/kg of 10% solution) given slowly.
• The treatment options for acute hyperkalemia include intravenous calcium gluconate, insulin/glucose, inhaled β-agonists, intravenous sodium bicarbonate, and hemodialysis, as outlined in the clinical management of hyperkalemia guidelines 1.

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. Dilute Calcium Gluconate Injection prior to use in 5% dextrose or normal saline and assess for potential drug or IV fluid incompatibilities [see Dosage and Administration (2. 5)].

For bolus intravenous administration: Dilute the dose [see Dosage and Administration (2. 2)] of Calcium Gluconate Injection in 5% dextrose or normal saline to a concentration of 10-50 mg/mL prior to administration. For continuous intravenous infusion: Dilute Calcium Gluconate Injection in 5% dextrose or normal saline to a concentration of 5.8-10 mg/mL prior to administration.

To prepare Calcium Gluconate for hyperkalemia, dilute the dose in 5% dextrose or normal saline.

• For bolus administration, dilute to a concentration of 10-50 mg/mL.
• For continuous infusion, dilute to a concentration of 5.8-10 mg/mL. Administer the dose slowly and do not exceed an infusion rate of 200 mg/minute in adults or 100 mg/minute in pediatric patients, including neonates 2.

From the Research

Preparation of Calcium Glucomate for Hyperkalemia

To prepare calcium glucomate for the treatment of hyperkalemia, the following steps can be considered:

• Calcium gluconate 10% can be dosed 10 mL intravenously for membrane stabilization, as indicated by 3.
• However, it is essential to note that the effectiveness of calcium gluconate in treating hyperkalemia may be limited to main rhythm disorders, as suggested by 4.
• The mechanism of calcium treatment for hyperkalemia may not be due to "membrane stabilization" but rather through Ca2+-dependent propagation, as proposed by 5.

Key Considerations

• Hyperkalemia is a life-threatening condition that requires prompt treatment, and calcium gluconate may be used as part of the treatment regimen, as discussed in 6.
• However, the use of calcium for hyperkalemia treatment is not supported by strong evidence, and other treatments such as insulin and glucose, inhaled or intravenous salbutamol, may be more effective, as indicated by 7.
• It is crucial to carefully evaluate the available evidence and consider the specific clinical context when preparing calcium glucomate for hyperkalemia treatment.

Administration

• Calcium gluconate can be administered intravenously, and the dosage may vary depending on the specific clinical scenario, as mentioned in 3.
• The administration of calcium gluconate should be guided by the patient's clinical condition, electrocardiogram (ECG) findings, and potassium levels, as discussed in 4 and 5.