- Treatment/ prevention of hypocalcemia
- Hyperkalemia with ECG changes
Central line preferred
IV Direct (NRP):
- in life threatening situations only: over 1 minute
- in cardiac arrest: may give over 10-20 seconds
IV intermittent infusion:
- symptomatic hypocalcemia: over 30 - 60 minutes
- hyperkalemia with ECG changes: over 30 minutes; can be given over 5-10 minutes if unstable
IV continuous infusion:
- for maintenance calcium replacement
- Life threatening situation (i.e. VT, wide QRS or cardiac arrest in the presence of hyperkalemia or hypocalcemia): 60 - 100 mg/kg/dose of calcium gluconate 10% (0.6 to 1 mL/kg/dose of calcium gluconate 10% undiluted)
- Symptomatic hypocalcemia: 50 - 200 mg/kg/dose of calcium gluconate
- Hyperkalemia with ECG changes: 50 - 100 mg/kg/dose of calcium gluconate
- Maintenance: 0.5 to 1.5 mmol/kg/day of elemental calcium
- 10 mmol/L (0.01 mmol/mL) of elemental calcium at a TFI of 60 to 140 mL/kg/day will provide 0.6 to 1.4 mmol/kg/day of elemental calcium
- 16 mmol/L (0.016 mmol/mL) of elemental calcium at a TFI of 60 to 140 mL/kg/day will provide 1 to 2.2 mmol/kg/day of elemental calcium
- For exchange blood transfusion in the newborn: calcium gluconate diluted to 50 mg/mL - Take 1 mL (100 mg) and add to 1 mL of D5W for a final concentration of 50 mg/mL. Administer 100 mg (2 mL) over 1 minute as a slow bolus in pulses during the procedure for every 100 mL of blood transfused
- CVS: bradycardia with rapid administration
- Miscellaneous: tissue necrosis with extravasation
- HR
- Injection site
- Calcium levels
IV Direct:
- Undiluted 10% Calcium Gluconate (life-threatening conditions only)
- 10% = 100 mg/mL of calcium gluconate
IV intermittent infusion:
- CHEO: premixed syringe of calcium gluconate 50 mg/mL available from PICU medication cabinet.
- TOH:
- Calcium gluconate 10% (100 mg/mL):
- Take 5 mL (500 mg) and add to 5 mL of D5W
- Final concentration: 50 mg/mL
- Calcium gluconate 10% (100 mg/mL):
IV continuous infusion:
- CHEO: prepared by pharmacy
- TOH
- Total volume = 250 mL - use a new bag
- Calcium gluconate 10% (100 mg/mL = 0.23 mmol/mL of elemental Ca)
- Take 11 mL (2.53 mmol) add to 250 mL of IV fluids
- Final concentration: elemental calcium 10 mmol/L (0.01 mmol/mL)
- Calcium gluconate 10% (100 mg/mL = 0.23 mmol/mL of elemental Ca)
- Take 19 mL (4.37 mmol) add to 250 mL of IV fluids
- Final concentration: elemental calcium 16 mmol/L (0.016 mmol/mL)
- Calcium gluconate 10% (100 mg/mL = 0.23 mmol/mL of elemental Ca)
- Total volume = 250 mL - use a new bag
To add to Protein/Dextrose bag of 100 mL - always use a new bag
- Calcium gluconate 10% (100 mg/mL =0.23 mmol/mL of elemental Ca)
- Take 4.5 mL (1.04 mmoL) add to 100 mL of IV fluids
- Final concentration: elemental calcium 10 mmol/L (0.01 mmol/mL)
- Calcium gluconate 10% (100 mg/mL = 0.23 mmol/mL of elemental Ca)
- Take 7.5 mL (1.72 mmoL) add to 100 mL of IV fluids
- Final concentration: elemental calcium 16 mmol/L (0.016 mmol/mL)
| TFI (mL/kg/day) |
Calcium 10 mmol/L Ca provided (mmol/kg/day) |
Calcium 16 mmol/L Ca provided (mmol/kg/day) |
|---|---|---|
| 60 | 0.6 | 0.96 |
| 80 | 0.8 | 1.28 |
| 100 | 1 | 1.6 |
| 120 | 1.2 | 1.92 |
| 140 | 1.4 | 2.24 |
- Solutions Compatible: D5W, D10W, 0.9% NaCl, dextrose-saline combinations
- Y-site Compatible: amino acids and dextrose (dependent of many factors - consult pharmacy), gentamicin, heparin, KCl (up to 40 mmol/L), tobramycin
- Incompatible: Fluconazole
Calcium gluconate 10% contains 100 mg/mL of calcium gluconate and is equivalent to 9.3 mg/mL of elemental calcium (0.23 mmol/mL)
-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 22nd Edition. Hudson: Lexi-Comp Inc.; 2015
-American Society of Health-System Pharmacists (ASHP). Handbook on Injectable Drugs. 19th Edition. Bethesda: ASHP; 2017
- Ogunlesi TA, Lesi FEA. Prophylactic intravenous calcium therapy for exchange blood transfusion in the newborn. Cochrane Database of Systematic Reviews 2014, Issue 3. Art.No.: CD011048. DOI:10.1002/14651858. CD011048