NAME OF DRUG

calcium gluconate

CLASSIFICATION

Electrolyte

ALTERNATE NAME

 INDICATIONS

 treatment of hypocalcemia in those conditions requiring prompt increases in plasma calcium

 for emergency cardiotonic effect

 RECONSTITUTION AND STABILITY

 stable at room temperature

 do not use if crystals are present

 COMPATIBILITY

 compatible with most commonly used IV solutions

 compatible via Y site with amikacin, aminophylline, cefazolin, ciprofloxacin, clindamycin, dimenhydrinate,
diphenhydramine, dopamine, epinephrine, erythromycin, fentanyl, folic acid, furosemide, gentamicin,
heparin, hydrocortisone, insulin regular, labetalol, lidocaine, magnesium sulphate, meperidine,
metoclopramide, metronidazole, midazolam, milrinone, morphine, MVI, norepinephrine, octreotide,
penicillin G, piperacillin-tazobactam, potassium chloride, procainamide, prochlorperazine, propofol,
ranitidine, thiamine, tobramycin, vancomycin, verapamil, vitamin K

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  incompatible with ceftriaxone, dobutamine,  methylprednisolone, sodium bicarbonate

 ROUTES OF ADMINISTRATION

 IV direct 
o may be given undiluted at a rate not exceeding 200 mg calcium gluconate per minute (= 2
mL/minute or  0.9 mEq/minute)
 IV intermittent 
o dilute in 50-100mL minibag and administer over 15-30 minutes
o rate should not exceed 200 mg calcium gluconate per minute (= 3 g or 30mL calcium gluconate
10% over 15 minutes)
 IV infusion - administered over 3-24 hours

 VH & HSC ADMINISTRATION POLICY

B - Direct IV route restricted to nurses in Special and Critical Care areas. On general nursing units the direct IV
route must be administered by a physician.

 DOSAGE

Adult

Hypocalcemia:

 usual initial IV dose for hypocalcemia: 7-14 mEq calcium (15-30 mL calcium gluconate) IV in 50-100mL
NS or D5W over 15-30 minutes; may follow with infusion of 0.3-0.8% solution (30-40 mL calcium
gluconate in 500-1000 mL IV solution) administered over 3-12 hours

Treatment of hyperkalemia:

 1g (10mL calcium gluconate) IV over 5 minutes;  if life-threatening complications of hyperkalemia persist,

a second dose may be considered, however, further dosing requires careful monitoring of ionized calcium
 Refer to potassium chloride monograph for complete guidelines for treatment of hyperkalemia (under
section "Potential Hazards of Parenteral Administration")

NOTE: 10mL calcium gluconate 10% contains 1g calcium gluconate (= 93mg calcium or 4.6 mEq calcium or 2.3
mmol calcium)

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

 too rapid IV: cardiotoxicity, hypotension, local thrombophlebitis, tingling sensation, calcium taste, flushing,
nausea, vomiting, sweating
 irritation on extravasation
 SC, IM routes are NOT USED because of severe sloughing and necrosis

 IMPORTANT IMPLICATIONS

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  antidote for overdose - IV magnesium sulphate
 caution in digitalized patients, renal disease
 serum calcium levels should be monitored

Rev. Oct 2007

Calcium Gluconate
Calcium Gluconate Drug Description

Calcium Gluconate
Injection, USP 10%

Sterile, Nonpyrogenic
0.68 mOsmoI/mL 680 mOsmol/L
C a++ 0.465 mEq/mL pH (6.0-8.2)

100 mL PHARMACY BULK PACKAGE

NOT FOR DIRECT INFUSION
CAUTION: For Intravenous Use. Not recommended for Intramuscular or Subcutaneous use.

DRUG DESCRIPTION
Calcium Gluconate is the calcium salt of gluconic acid, an oxidation product of glucose, and contains
9.3% calcium, which is about one-third of the calcium in strength of calcium chloride USP. Since it is
soluble to the extent of only one part in 30 parts of cold water, the 10% solution is supersaturated and is
stabilized by the addition of calcium saccharate tetrahydrate 0.46% w/v (which supplies calcium 6.2%).
Each mL contains 98 mg of calcium gluconatemonohydrate, 4.6 mg of calcium saccharate tetrahydrate,
and Water for Injection USP, q.s. Each mL provides 9.3 mg (0.465 milliequivalents) of calcium.

The 100 mL Pharmacy Bulk Package contains many single doses for use in a pharmacy admixture
program in the preparation of parenteral fluids. See directions for dispensing from the 100 mL Pharmacy
Bulk Package. pH is adjusted with sodium hydroxide and/or hydrochloric

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Calcium gluconate Dosing Information

Usual Adult Dose for Hypocalcemia:

Intravenous:

500 to 2000 mg (5 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. The dose may
be increased as needed. The usual daily dosage ranges from 1000 to 15,000 mg (10 to 150 mL)
in divided doses or as a continuous infusion. Doses may be repeated every 1 to 3 days as needed
and tolerated to normalize the serum calcium level.

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Oral:

500 to 2000 mg orally 2 to 4 times a day.

Usual Adult Dose for Hypermagnesemia:

1000 to 2000 mg (10 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose
may be repeated as necessary in severe cases of hypermagnesemia (where discontinuation of
exogenous magnesium is inadequate) to temporarily reverse many of the toxic effects of
magnesium in the central nervous system.

Usual Adult Dose for Hyperkalemia:

500 to 3000 mg (5 to 30 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose may
be repeated as necessary in cases of extreme hyperkalemia cardiotoxicity when P waves are
absent, the QRS complexes are widened, and when continuous ECG monitoring is available. The
use of calcium does not reduce the serum potassium level, but counteracts the effects of
hyperkalemia on cardiac excitability.

Usual Adult Dose for Exchange Transfusion:

300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2
mL/min.

Usual Adult Dose for Osteoporosis:

1000 to 1500 mg/day orally in divided doses.

Usual Pediatric Dose for Hypocalcemia:

IV:
< 1 month: 200 to 800 mg/kg/day as a continuous infusion or in divided doses every 6 hours.
>= 1 month: 200 to 500 mg/kg/day as a continuous infusion or in divided doses every 6 hours.

Oral:
>= 1 year: 200 to 500 mg/kg/day in 4 divided doses.

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 CALCIUM GLUCONATE INJECTION USP

Astra
Electrolyte Replenisher
 
Action And Clinical Pharmacology: Calcium plays important physiologic
roles, many of which are not completely understood. Calcium is
essential for the proper functioning of nerve and muscle, where it has
a major influence on stimulation thresholds and the release of
neurotransmitters. It is necessary for muscle contraction, renal
function, maintenance of the integrity of membranes, coagulation of
the blood, and cardiac function. Calcium also plays regulatory roles
in the release and storage of neurotransmitters and hormones, in the
uptake and binding of amino acids, and in cyanocobalamin (vitamin
B12) absorption and gastrin secretion.

Calcium is present in small quantities in the extracellular fluid and to

a minor extent in the structure of cytoplasm of cells of soft tissue. To
fulfill its vital function, ionized calcium must be available to the
appropriate tissues in the proper concentrations. An endocrine
control system ordinarily keeps the plasma concentrations of ionized
calcium within narrow limits. Intracellular concentrations of ionized
calcium are also strictly regulated by control of the exchange of ions
between the cell and its environment and between intracellular
compartments. The principal endocrine factors that control calcium
metabolism are parathyroid hormone, calcitonin and vitamin D.
Derangements in calcium metabolism may occasionally require the
rapid restoration of calcium concentrations in body fluids by the
infusion of i.v. calcium salts.

For the treatment of hypocalcemia for those conditions requiring a

Indications And Clinical Uses:
prompt increase in blood plasma calcium concentrations, such as neonatal tetany and tetany due
to parathyroid deficiency, vitamin D deficiency and alkalosis. It is also indicated for the
prevention of hypocalcemia during exchange transfusions.

Calcium gluconate has also been administered as adjunctive therapy in a number of conditions,
including the following: rickets; osteomalacia; insect bites or stings such as Black Widow Spider
bites; sensitivity reactions, particularly when characterized by urticaria; as an aid in the treatment
of depression due to overdosage of magnesium sulfate; as an aid in management of the acute
symptoms in lead colic; in cardiac resuscitation, particularly after open heart surgery when
epinephrine has failed to improve weak or ineffective myocardial contractions.

In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity provided the
patient is not receiving digitalis therapy.

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Contra-Indications: Hypercalcemia and hypercalciuria (e.g., in hyperparathyroidism, vitamin D
overdosage, decalcifying tumors such as plasmocytoma, bone metastases); severe renal disease;
calcium loss due to immobilization, ventricular fibrillation. The injection of calcium preparations
is strictly contraindicated in digitalized patients. tag_WarningWarnings

Manufacturers' Warnings In Clinical States: For i.v. use only.

The gluconate salt is not irritating to the veins but has been reported to cause skin necrosis and
sloughing in infants. The i.m. route should not be used because it is irritating, painful, and may
cause abscess formation.
Precautions: In mild hypercalciuria (exceeding 300 mg/24 hours) as well as in chronic renal
failure, or where there is evidence of stone formation in the urinary tract, adequate checks must
be kept on urinary calcium excretion. If necessary, the dosage should be reduced or calcium
therapy discontinued.

High vitamin D intake should be avoided during calcium therapy unless especially indicated.

Tissue irritation and necrosis may occur with i.m. injection especially in infants and small
children; this route should be avoided. High dose calcium therapy by any of the parenteral routes
should always be accompanied by very careful monitoring of blood concentration and urinary
calcium excretion, particularly in children. Treatment should be stopped at once if blood calcium
exceeds 2.62 to 2.74 mmol/L (105 to 119 mg/L) or if more than 0.12 mmol/kg (5 mg/kg) is
excreted in the urine in a period of 24 hours. Heart rhythm should also be monitored.

Injections should be made slowly through a small needle into a large vein in order to avoid too
rapid an increase in serum calcium and extravasation of calcium solution into the surrounding
tissue with resulting necrosis. It is particularly important to prevent a high concentration of
calcium from reaching the heart because of the danger of cardiac syncope. If injected into the
ventricular cavity in cardiac resuscitation, it must not be injected into the myocardial tissue.

Rapid injection of calcium gluconate may cause vasodilation, decreased blood pressure,
bradycardia, cardiac arrhythmias, syncope and cardiac arrest.

Drug Interactions: The ionotropic and toxic effects of cardiac glycosides and calcium are
synergistic and arrhythmias may occur if these drugs are given together (particularly when
calcium is given i.v.). I.V. administration of calcium should be avoided in patients receiving
cardiac glycosides; if necessary, calcium should be given slowly in small amounts.

Calcium complexes tetracycline antibiotics rendering them inactive. The 2 drugs should not be
given at the same time orally, nor should they be mixed for a parenteral administration.

Calcium Gluconate Injection has been reported to be incompatible with i.v. solutions containing
various drugs. Published data are too varied and/or limited to permit generalization, and
specialized reference should be consulted for specific information.
High vitamin D intake should be avoided during calcium therapy unless especially indicated.

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Dosage And Administration: The dose is dependent on the requirements of the individual patient.
I.V. calcium gluconate injection must be administered slowly, e.g. approximately 1.5 mL over a
period of 1 minute.

To aid in converting: 1 g of elemental calcium=25 mmol elemental calcium=50 mEq elemental

calcium=11.1 g calcium gluconate=111 mL of a 10% solution of calcium gluconate.

Adults: Initially, 5 to 20 mL of a 10% solution (500 mg to 2 g) injected slowly i.v. This dose may
be repeated until tetany is controlled. A 0.3 to 0.8% solution [30 to 40 mL of a 10% solution in
500 to 1 000 mL of sodium chloride injection or dextrose 5% in water (D5W)] may then be
infused by slow drip within a 3 to 12-hour period. The maximum dosage for adults is 15 g (150
mL of a 10% solution).

Children: The usual dose is 200 to 500 mg/kg/day well diluted and administered slowly i.v. in
divided doses. Doses above 500 mg/kg/day are not recommended.
Adverse Reactions: Parenteral calcium may cause flushing, nausea, vomiting, drowsiness, sweating
and hypotension. Vasomotor collapse may ensue if i.v. injection is too rapid.

Symptoms And Treatment Of Overdose: Symptoms: Untoward effects which may occur with
parenterally administered calcium are related to the rate of injection.

Nausea, vomiting, diarrhea, sensations of heat and sweating; arrhythmias, hypotension,

circulatory collapse.

Treatment: The patient should be in the horizontal position. Treat shock in the usual fashion.
Availability And Storage: Each mL of sterile, nonpyrogenic, hypertonic solution contains: total
calcium 0.465 mEq (9.3 mg), derived from calcium gluconate 94 mg and calcium D-saccharate
tetrahydrate 4.5 mg (equivalent to calcium D-saccharate anhydrous 3.5 mg) in water for
injection. Calcium D-saccharate provides 6% of the total calcium and stabilizes the
supersaturated solution of calcium gluconate. Preservative-free. Single use vials of 10 mL.

Sodium hydroxide and/or hydrochloric acid is used to adjust pH to 6.0 to 8.2. The osmolality is
0.7 mOsmol/mL (calc.).

Supersaturated solutions are prone to precipitation. If precipitation is evident, vials may be

heated to 80°C in a dry heat oven for a minimum of 1 hour. Shake vigorously. Allow to cool to
room temperature before dispensing. The solution should not be used if the precipitate remains
after following the above procedure.

Store at room temperature (15 to 30°C). Protect from freezing. Do not use if solution is unclear.
Discard unused portion.

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Calcium gluconate Dosage, Interactions, Side Effects, How to Use

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Home > Drug Prescribing Database > C > Calcium gluconate

Calcium gluconate
Calcium gluconate (Kalcinate)
Calcium gluconate
( KAL-see-um GLUE-koh-nayt) Kalcinate (Rx, injection; OTC, tablets)
Classification: Calcium salt
See Also: See also Calcium Salts .
Uses: Mild hypocalcemia due to neonatal tetany, tetany due to parathyroid deficiency or vitamin D
deficiency, and alkalosis. Prophylaxis of hypocalcemia during exchange transfusions. Intestinal
malabsorption. Adjunct to treat insect bites or stings to relieve muscle cramping. Depression due to
magnesium overdosage. Acute symptoms of lead colic. Rickets, osteomalacia. Reverse symptoms of
verapamil overdosage. Decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura,
and exudative dermatoses (e.g., dermatitis herpetiformis). Pruritus due to certain drugs. Hyperkalemia to
antagonize cardiac toxicity (as long as client is not receiving digitalis).
Contraindications: IM, intramyocardial, or SC use due to severe tissue necrosis, sloughing, and abscess
formation.
How Supplied: Chew tablet: 650 mg; Injection: 100 mg /mL; Tablet: 486 mg, 500 mg, 650 mg, 975 mg
Dosage
?Chewable Tablets, Tablets Treatment of hypocalcemia.
Adults: 8.8-16.5 g/day in divided doses; pediatric: 0.5-0.72 g/kg/day in divided doses.
Nutritional supplement.
Adults: 8.8-16.5 g/day in divided doses.
?IV Only Treatment of hypocalcemia.
Adults: 2.3-9.3 mEq (5-20 mL of the 10% solution) as needed (range: 4.65-70 mEq/day). Children: 2.3
mEq/kg/day (or 56 mEq/m 2/day) given well diluted and slowly in divided doses. Infants: No more than 0.93
mEq (2 mL of the 10% solution).
Emergency elevation of serum calcium.
Adults: 7-14 mEq (15-30.1 mL). Children: 1-7 mEq (2.2-15 mL). Infants: Less than 1 mEq (2.2 mL).
Depending on client response, the dose may be repeated q 1-3 days.
Hypocalcemic tetany.
Children: 0.5-0.7 mEq/kg (1.1-1.5 mL/kg) t.i.d.-q.i.d. until tetany is controlled. Infants: 2.4 mEq/kg/day (5.2
mL/kg/day) in divided doses.
Hyperkalemia with cardiac toxicity.
2.25-14 mEq (4.8-30.1 mL) while monitoring the ECG. If needed, the dose can be repeated after 1-2 min.
Magnesium intoxication.
Initial: 4.5-9 mEq (9.7-19.4 mL). Subsequent dosage based on client response.
Exchange transfusion.
Adults: 1.35 mEq (2.9 mL) concurrent with each 100 mL citrated blood. Neonates: 0.45 mEq (1 mL)/100
mL citrated blood.
?IM Hypocalcemic tetany.
Adults: 4.5-16 mEq (9.7-34.4 mL) until a therapeutic response is noted.
Magnesium intoxication.
If IV administration is not possible