Parenteral Manual

Calcium gluconate

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Classification: 
Electrolyte
Original Date: 
August 2005
Revised Date: 
February 2017
Indications: 
  • Treatment of hypocalcemia for those conditions requiring prompt increase of plasma calcium          
  • For emergency cardiotonic effect
  • Treatment of hypermagnesemia
  • Treatment of hyperkalemia
Reconstitution and Stability: 

Stable at room temperature

 

Available in two forms:

1.  Premixed SYRINGE of calcium gluconate 50 mg/mL (5%)

    Available from Pharmacy, ED Resus, or PICU

    Administer via SYRINGE PUMP or IV direct

    For Intermittent Doses

 

2.Premixed MINIBAG of calcium gluconate 0.06 mmol/mL (25 mg/mL of calcium gluconate)

   Available from Pharmacy

   Administer via LARGE VOLUME PUMP

   For Continuous Infusions

Compatibility: 

- Solutions Compatible:  dextrose solutions, 0.9 % NaCl, dextrose-saline combinations, ringer's solution, ringer's lactate

- Additives/Above Cassette Compatible: furosemide, heparin

- Y-site Compatible: TPN (dependent on many factors- consult Pharmacy), KCl (up to 40 mmol/L)

- Incompatible: phosphate salts (concentration-dependent- consult Pharmacy), dobutamine, fluconazole, methylprednisolone

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct

YES - in emergency arrest situations
Usual dilution: < 100 mg/mL
Infusion rate: do not exceed 50-100 mg/minute
IV Intermittent Infusion YES  -SYRINGE PUMP
Usual dilution: 50 mg/mL

Infusion time: 10 to 30 minutes
Infusion rate: do not exceed 100 mg/minute
IV Continuous Infusion

YES  -LARGE VOLUME PUMP
Usual dilution: 0.06 mmol/mL (25 mg/mL of calcium gluconate)
Infusion rate: do not exceed 2 mL/kg/hour (50 mg calcium gluconate/kg/hr)
Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatrics:

 

-  Cardiopulmonary resuscitation: (for hypocalcemia, hyperkalemia or calcium channel toxicity, magnesium toxicity: 60 to 100 mg/kg/dose of calcium gluconate Q 10 minutes. Maximum: 3000 mg/dose

-  Hyperkalemia:  50 mg/kg/dose.  Maximum: 2000 mg/dose IV over 5 minutes.  May repeat x 2

 

Moderate to Severe Hypocalcemia

Use Premixed SYRINGE of calcium gluconate 50 mg/mL

Available from Pharmacy, ED resus or PICU

Administer via SYRINGE pump or IV direct

 

Dose: 25 to 50 mg/kg/dose  Max 3000 mg

 

Mild Hypocalcemia

Use Premixed MINIBAG of calcium gluconate 0.06 mmol/mL

Available from Pharmacy

Administer via LARGE VOLUME pump

 

Dose: 1-2 mL/kg/hour IV x 4 hours (then reassess)

 

PRE and POST Oxaliplatin for patients over 40 kg:
Calcium gluconate 1000 mg and Magnesium sulfate 1000 mg in 250 mL D5W over 30 minutes

Potential hazards of parenteral administration: 
  • Too rapid IV - cardiotoxicity (bradycardia, dysrhythmias), hypotension, local thrombophlebitis, tingling sensation, calcium taste, flushing, nausea, vomiting, sweating, dizziness, confusion
  • Irritation on extravasation - tissue necrosis and sloughing. If extravasation occurs, see Treatment of Infiltrated Vesicant or Irritant Drugs Guidelines on CHEOnet.  
  • SC, IM routes are NOT recommended due to possibility of severe sloughing, necrosis, abscess formation
  • Avoid administration via scalp veins or small hand or foot veins
Notes: 
  • Monitor for bradycardia, dysrhythmias and extravasation; serum calcium, phosphate and magnesium levels      
  • Antidote for overdose - magnesium sulphate IV                                                
  • Use with extreme caution in digitalized patients, hypercalcemia will precipitate digoxin toxicity
  • 10% solution contains 100 mg/mL calcium gluconate, 0.23 mmol/mL (0.47 mEq/mL) calcium, or 9.3 mg/mL elemental calcium
  • Serum calcium levels can be affected by low albumin states or acid/base imbalances; direct measurement of ionized calcium is the most accurate
  • Normal levels at CHEO:
    Ionized Calcium 1.15 - 1.35 mmol/L
    Ionized Calcium pH 7.4 1.10 - 1.30 mmol/L

         

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