From the Guidelines
Calcium gluconate should be administered intravenously for rapid correction of hypocalcemia, particularly in emergency situations, with a standard adult dose of 1-2 grams (10-20 mL of 10% solution) given slowly over 10-20 minutes, as recommended by the most recent guidelines 1.
Administration and Dosage
The administration of calcium gluconate should be done with careful monitoring of heart rate and blood pressure during administration. For severe symptomatic hypocalcemia, up to 10-20 mL of 10% calcium gluconate may be given, followed by continuous infusion at 0.5-2 mg/kg/hour.
Indications and Precautions
Common indications for calcium gluconate include hypocalcemic tetany, hyperkalemia (to stabilize cardiac membranes), magnesium toxicity, and calcium channel blocker overdose. However, it is essential to note that calcium gluconate may not be the preferred agent in all situations, such as in the setting of abnormal liver function, where calcium chloride may be preferred 1.
Side Effects and Interactions
Side effects of calcium gluconate may include flushing, hypotension, bradycardia, and cardiac arrhythmias if administered too rapidly. Additionally, calcium gluconate should be given cautiously in patients taking digoxin, as it may potentiate digoxin toxicity.
Clinical Context
In the context of tumor lysis syndrome, calcium gluconate may be used as a supportive therapy for hyperkalemia-induced cardiac arrhythmias, but its use should be carefully considered, as it may lead to increased tissue and renal precipitation of calcium phosphate 1.
Recent Guidelines
The most recent guidelines from 2023 recommend the use of calcium chloride over calcium gluconate in certain situations, such as in the setting of massive transfusion, due to its higher content of elemental calcium 1. However, calcium gluconate remains a viable option in many clinical scenarios, particularly when calcium chloride is not available or when tissue irritation is a concern.
From the FDA Drug Label
Calcium Gluconate Injection is a form of calcium indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia. Administer intravenously (bolus or continuous infusion) via a secure intravenous line Individualize the dose within the recommended range in adults and pediatric patients depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia.
The administration of calcium gluconate is via intravenous route, and the dosage should be individualized based on the severity of symptoms, serum calcium level, and acuity of onset of hypocalcemia 2.
- Key considerations for administration include:
- Administering via a secure intravenous line
- Diluting with 5% dextrose or normal saline and infusing slowly to avoid adverse reactions
- Monitoring serum calcium levels and ECG for cardiac arrhythmias 2.
From the Research
Administration of Calcium Gluconate
- Calcium gluconate is administered intravenously to treat severe hypocalcemia, with an initial dose of 10-20 mL of 10% calcium gluconate in 50-100 mL of 5% dextrose over 10 minutes with ECG monitoring 3.
- The dose can be repeated until the patient is asymptomatic, followed by a calcium gluconate infusion of 100 mL of 10% calcium gluconate in 1 L of normal saline or 5% dextrose at 50-100 mL/h 3.
- Calcium gluconate is preferred over calcium chloride due to less irritation of the vessel wall and better compatibility with other nutrients in parenteral nutrition 4.
Treatment of Hypocalcemia
- Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in acute hypocalcemia 5.
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 5.
- In hypoparathyroidism, recombinant human PTH(1-84) has been approved for treatment, which can correct serum calcium levels and reduce the daily requirements of calcium and active vitamin D supplements 5.
Parenteral Calcium Administration
- There is no clear evidence that parenteral calcium supplementation impacts the outcome of critically ill patients 6.
- Parenteral calcium administration can increase serum ionized calcium concentration, but the trials showed considerable statistical heterogeneity and differed extensively in population, indication, and threshold of hypocalcemia 6.