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
• incompatible with ceftriaxone, dobutamine,  methylprednisolone, sodium bicarbonate

 ROUTES OF ADMINISTRATION

• IV direct 
  • 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 
  • dilute in 50-100mL minibag and administer over 15-30 minutes
  • 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

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

Rev. Oct 2007