1 vial


Calcium gluconate

  1. Hypocalaemia (particular if there is refractory shock or bleeding)

  2. ECG abnormalities caused by hyperkalaemia (acts as a membrane stabiliser)

  3. Magnesium toxicity

Preferably give via a central line (if this is present)
Injection undiluted solution. 1gm calcium gluconate/10ml (i.e. 10% solution). 2.2mmol of calcium per 10ml. Calcium gluconate is a clear colourless solution
For direct IV injection, inject undiluted solution at a rate not exceeding 2ml/min
For intermittent infusion, add 1gm of calcium gluconate to 50ml of compatible IV fluid and administer over 10 to 20 minutes. Compatible with the following IV fluids:
D5W normal saline glucose and sodium chloride Hartmanns
Store at room temperature below 30°C

Usually give one vial and repeat as necessary.
(Note 1 vial of calcium gluconate contains approximately one third the amount of calcium that is present in a vial of
calcium chloride.)

0.5ml/kg (max 20ml)

Dose as in normal renal function


  1. Hypercalcaemia,

  2. Digitalis toxicity.

Calcium gluconate should be injected into a large vein very slowly, as it may cause peripheral vasodilatation and a cutaneous burning sensation (it is preferable to administer it centrally if the patient has a central line)
Avoid IV calcium in patients on digoxin where possible due to the risk of inducing digoxin toxicity.


Calcium gluconate injection, 10% is irritating to veins and must not be injected into tissues, since severe necrosis and sloughing may occur. Great care should be taken to avoid extravasation or accidental injection into perivascular tissues.

Laboratory Tests:
An arterial or venous blood gas should be repeated after administration of calcium chloride to check the ionised calcium.

Drug/Laboratory Test Interactions:
None known

Hypercalcaemia increases the risk of digitalis toxicity. Because of the danger involved in the simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive intravenous injections of calcium unless the indications are clearly defined.

The major side effects are those due to hypercalcaemia as a result of inadvertent over dosing.
Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.
Polyuria, polydipsia, anorexia, weight loss, nocturia, conjunctivitis (calcific), pancreatitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, elevated Cr, albuminuria, hypercholesterolemia, elevated AST and ALT, ectopic calcification, nephrocalcinosis, hypertension, cardiac arrhythmias, dystrophy, sensory disturbances, dehydration, apathy, arrested growth, urinary tract infections, and, rarely, overt psychosis.