Formulary
Calcium gluconate: Indications, Dosing, Side Effects and Interactions
Calcium gluconate clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 3 min read
Calcium gluconate: Indications, Dosing, Side Effects and Interactions
Calcium gluconate clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**Acute severe hyperkalaemia [plasma-potassium concentration 6.5 mmol/litre or greater, or in the presence of ECG changes]**
- **Adult** (By Slow Intravenous Injection): 30 mL for 1 dose, calcium gluconate 10% (providing approximately 6.8 mmol of calcium) should be administered, repeat dose if no improvement in ECG within 5 to 10 minutes.
**Calcium deficiency,Mild asymptomatic hypocalcaemia**
- **Adult** (By Mouth): Dose according to requirements.
**Calcium deficiency, Mild asymptomatic hypocalcaemia for calcium gluconate**
- **Neonate** (By mouth): 0.25 mmol/kg 4 times a day, dose adjusted according to response.
- **Child 1 month-4 years** (By mouth): 0.25 mmol/kg 4 times a day, dose adjusted according to response.
- **Child 5-11 years** (By mouth): 0.2 mmol/kg 4 times a day, dose adjusted according to response.
- **Child 12-17 years** (By mouth): 10 mmol 4 times a day, dose adjusted according to response.
**Acute hypocalcaemia [urgent correction] for calcium gluconate**
- **Neonate** (By slow intravenous injection): 0.11 mmol/kg for 1 dose, to be given over 5-10 minutes, some units use a dose of 0.46 mmol/kg (2 mL/kg calcium gluconate 10%) for hypocalcaemia in line with US practice.
- **Child** (By slow intravenous injection): 0.11 mmol/kg for 1 dose (max. per dose 4.5 mmol), to be given over 5-10 minutes (10 mL calcium gluconate 10% is equivalent to approximately 2.25 mmol of calcium).
**Acute hypocalcaemia [maintenance] for calcium gluconate**
- **Neonate** (By continuous intravenous infusion): 0.5 mmol/kg daily, adjusted according to response, dose to be given over 24 hours, use oral route as soon as possible due to risk of extravasation.
- **Child 1 month-1 year** (By continuous intravenous infusion): 1 mmol/kg daily, adjusted according to response, dose to be given over 24 hours, use oral route as soon as possible due to risk of extravasation; Usual maximum 8.8 mmol.
- **Child 2-17 years** (By continuous intravenous infusion): 8.8 mmol daily, adjusted according to response, dose to be given over 24 hours, use oral route as soon as possible due to risk of extravasation.
**Acute severe hyperkalaemia [prevention of arrhythmias] for calcium gluconate**
- **Neonate** (By slow intravenous injection): 0.11 mmol/kg for 1 dose, to be given over 5-10 minutes, repeat dose if ECG changes persist after 5-10 minutes.
- **Child** (By slow intravenous injection): 0.11 mmol/kg for 1 dose (max. per dose 6.75 mmol), to be given over 5-10 minutes (10 mL calcium gluconate 10% is equivalent to approximately 2.25 mmol of calcium), repeat dose if ECG changes persist after 5-10 minutes.
Cautions
For all calcium salts History of nephrolithiasis; sarcoidosis
Contraindications
For all calcium salts Conditions associated with hypercalcaemia (e.g. some forms of malignant disease); conditions associated with hypercalciuria (e.g. some forms of malignant disease)
Side effects
For all calcium salts Uncommon Constipation; diarrhoea; hypercalcaemia; nausea Rare or very rare Gastrointestinal disorder Side-effects For calcium gluconate General side-effects: Frequency not known Arrhythmias Specific side-effects: Frequency not known With intravenous use Circulatory collapse; feeling hot; hyperhidrosis; hypotension; vasodilation; vomiting
Interactions
**Severe interactions:**
- Cardiac glycosides The effects of digoxin and other cardiac glycosides may be potentiated by calcium, which may result in serious toxicity.
**Other interactions (4):**
- Adrenaline / Epinephrine Co-administration of calcium and adrenaline/epinephrine attenuates epinephrine's -adrenergic effects in postoperative heart surgery patients (see section 4.4).
- Calcium antagonists Calcium may antagonise the effect of calcium antagonists (calcium channel blockers).
- Thiazide diuretics Combination with thiazide diuretics may induce hypercalcaemia as these medicinal products reduce renal calcium excretion.
- Physical incompatibilities including interaction with ceftriaxone and sodium bicarbonate See section 4.4 and section 6.2.
Renal impairment
For all calcium salts Use with caution. M
Medicinal forms
Tablet,Tablet,Solution
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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