From the FDA Drug Label
Table 1 provides dosing recommendations for Calcium Gluconate Injection in mg of calcium gluconate for neonates, pediatric and adult patients. The dose of Calcium Gluconate Injection for neonates is not explicitly stated in the provided text, but it is mentioned that Table 1 provides dosing recommendations for neonates. However, the actual table is not provided in the text.
- The administration rate should not exceed 100 mg/minute in pediatric patients, including neonates.
- The concentration for continuous intravenous infusion should be 5.8-10 mg/mL. Since the actual dosing information for neonates is not provided in the text, a conservative clinical decision would be to consult the actual Table 1 or other reliable sources for the recommended dosage of Calcium Gluconate Injection in neonates 1.
From the Research
For intravenous calcium administration in neonates, the recommended dose is 10 to 20 mg/kg of elemental calcium, which can be achieved with 1-2 mL/kg/dose of 10% calcium gluconate, administered as a slow intravenous infusion. This recommendation is based on the most recent and highest quality study available, which emphasizes the importance of calcium replacement in the treatment of hypocalcemia in newborns 2. The study highlights that elementary calcium replacement of 40 to 80 mg/kg/d is recommended for asymptomatic newborns, while symptomatic cases require more urgent treatment.
When administering calcium, it is crucial to use a small peripheral vein with good blood flow and to monitor the IV site closely for extravasation, which can cause severe tissue damage. Additionally, calcium should never be mixed with bicarbonate solutions, as this can cause precipitation. Cardiac monitoring is also recommended due to the risk of bradycardia associated with calcium administration.
Key considerations for calcium administration in neonates include:
- Using 10% calcium gluconate for intravenous administration
- Administering the dose slowly over 5-10 minutes for acute hypocalcemia
- Providing maintenance therapy as a continuous infusion at 500-800 mg/kg/day (45-75 mg/kg/day of elemental calcium)
- Reserving calcium chloride for central line administration due to its higher irritancy to veins
- Monitoring for signs of hypocalcemia, such as tetany or hypocalcemic convulsion, and adjusting the treatment accordingly.
It is essential to note that premature infants are particularly susceptible to hypocalcemia due to interrupted maternal calcium transfer and immature parathyroid function, making timely and appropriate calcium replacement critical in this population 2.