Calcium Gluconate

ADMINISTRATION ROUTES:

IV

ALTERNATIVE NAMES:

Calcium gluconate

ICU INDICATIONS:

1. Hypocalaemia (particular in setting of refractory shock or bleeding)

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

3. Magnesium toxicity

PRESENTATION AND ADMINISTRATION:

IV:

Preferably give via a central line (if this is present)

Injection of undiluted solution of 1 gm calcium gluconate in 10 mL (i.e. 10% solution). Contains 2.2 mmol of calcium per 10 mL. Calcium gluconate is a clear colourless solution

For direct IV injection, inject undiluted solution at a rate not exceeding 2 mL/min

For intermittent infusion, add 1 gm of calcium gluconate to 50 mL of compatible IV fluid and administer over 10 to 20 minutes.

Compatible with the following IV fluids:

5% dextrose, normal saline, glucose and sodium chloride, Hartmanns.

Store at room temperature below 30°C

DOSAGE:

IV:

Give 1 gm (1 vial of 10 mL) and repeat as necessary

Note: 1 vial of calcium gluconate contains approximately one third of the amount of calcium that is present in one vial of calcium chloride

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

0.5 mL/kg (max 20 mL)

CLINICAL PHARMACOLOGY:

Calcium

CONTRAINDICATIONS:

1. Hypercalcaemia

2. Digitalis toxicity

WARNINGS:

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

PRECAUTIONS:

General:

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

IMPORTANT DRUG INTERACTIONS IN ICU:

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 digitalised patient should not receive intravenous injections of calcium unless the indications are clearly defined

ADVERSE REACTIONS:

The major side effects are those due to hypercalcaemia as a result of inadvertent over dosing

Early:

Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.

Late:

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