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CALCIUM GLUCONATE
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.

Usual Diluents
D5W, NS     Calcium chloride link

Standard Dilutions   [Amount of drug] [Infusion volume] [Infusion rate]
[0 to 1 gram] [50 ml] [30 min]
[Over 1 gram] [100 ml] [1 hour]

Continuous infusion: Initially multiply ( 0.5 x Wt (kg) X 24 ) / 93 mg = number of grams of calcium gluconate needed. Add calculated amount to 500 to 1000 ml D5W or NS. A continuous infusion may be used in symptomatic patients with hypocalcemia. Infusion rate: 0.3 to 2 mg/kg/hr based on elemental calcium

Stability / Miscellaneous
1 gram= 4.65 meq (93 mg) 10 ml.

Maximum IV rate: 1.5 ml/min or approximately 1 gram/ 7 minutes.

Too rapid injection may decrease blood pressure or cause cardiac syncope. Calcium administration: (Onset: rapid Duration: 30min to 2 hours. ).

Recommended only in cases of hyperkalemia, hypocalcemia, or calcium antagonist blockade.
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Treatment of hypocalcemia: Acute hypocalcemic tetany (unless induced by alkalosis): give 1 gram calcium gluconate IV over 5 - 15 minutes. After 1-2 hours may be necessary to repeat dose or add 2-3 grams calcium gluconate to 250-500ml and infuse over 12-24hours.

----Alternatively----
Symptomatic patient: give 1 gram calcium gluconate over 5 - 15 minutes q1-2hours. If Tetany returns after 6 hours (3 grams calcium gluconate given) start continuous infusion [5-10g of calcium gluconate /1000 ml D5W infused at rate to prevent tetany-usually 30 to 100 ml/hr]. Make sure magnesium levels are corrected first - patients with hypocalcemia and hypomagnesemia will not respond to calcium replacement. Alternative therapy: give 0.3 to 2 mg elemental calcium/kg/hour as a continuous infusion.

Asymptomatic patient: 1 gram calcium gluconate IV q6-12h with careful monitoring of Ca++ levels. Monitoring: during intensive therapy, monitor calcium levels at least twice daily.


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Differentiation of hypoparathyroidism vs Vitamin D deficiency:
Hypoparathyroidism: Decreased serum Ca++/serum PO4 increased/Alk phos normal.
Vitamin D deficiency: decreased Ca++ & PO4/ Alk phos increased.


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Calcium channel blocker blockade: give 0.01 to 0.04 ml/kg of 10% CaCl IV over 5-10min; may repeat q10minutes. May also use calcium gluconate 0.5-0.8g IV q10min. Some recommend 1gram CaCL over 5 minutes, q10-20min x 3 to 4 doses. Some degree of hypercalcemia may be necessary. Calcium therapy is more effective in overcoming mild toxicity vs massive overdose since calcium channel blockade is noncompetitive.

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DRUG DESCRIPTION
Calcium Gluconate is the calcium salt of gluconic acid, an oxidation product of glucose, and contains 9.3% calcium, which is about one-third of the calcium in strength of calcium chloride USP. Since it is soluble to the extent of only one part in 30 parts of cold water, the 10% solution is supersaturated and is stabilized by the addition of calcium saccharate tetrahydrate 0.46% w/v (which supplies calcium 6.2%). Each mL contains 98 mg of calcium gluconatemonohydrate, 4.6 mg of calcium saccharate tetrahydrate, and Water for Injection USP, q.s. Each mL provides 9.3 mg (0.465 milliequivalents) of calcium.


INDICATIONS
Calcium gluconate is used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyrodism and hypocalcemia due to rapid growth or pregnancy. It is also used in the treatment of black widow spider bites to relieve muscle cramping and as an adjunct in the treatment of rickets, osteomalacia, lead colic and magnesium sulfate overdosage. Calcium gluconate has also been employed to decrease capillary permeability in allergic conditions, nonthrombocytopenic purpura and exudative dermatoses such as dermatitis herpetiformis and for pruritus of eruptions caused by certain drugs. In hyperkalemia, calcium gluconate may aid in antagonizing the cardiac toxicity provided the patient is not receiving digitalis therapy.

DOSAGE AND ADMINISTRATION
Calcium Gluconate should be administered intravenously either directly or by infusion. The dose is dependent upon the individual requirements of the patient. Calcium Gluconate may also be administered by intermittent infusion at a rate not exceeding 200 mg/min, or by continuous infusion.

Usual Dosage
Adults: 500 mg - 2 grams (5-20 mL)

Children: 200-500 mg (2-5 mL)

Infants: not more than 200 mg (not more than 2 mL)

HOW SUPPLIED
Calcium Gluconate Injection, USP 10%

NDC 0517-3910-25 10% 10 mL Single Dose Vials packed in boxes of 25
NDC 0517-3950-25 10% 50 mL Single Dose Vials packed in boxes of 25
NDC 0517-3900-25 10% 100 mL Pharmacy Bulk Package packed in boxes of 25


Supersaturated solutions are prone to precipitation.

NOTE: If crystallization has occurred, warming in a 60°C water bath for 15-30 minutes with occasional shaking, may dissolve the precipitate. Cool to body temperature before use. The injection must be clear at the time of use. Parenteral drug products should be inspected visually for particulate matter and discoloration, whenever solution and container permit.

No preservative added. Unused portion of vial should be discarded. Use only if solution is clear and seal intact.

Store at controlled room temperature 15º- 30ºC (59º- 86ºF) (See USP).
The authors make no claims of the accuracy of the information contained herein; and these suggested doses and/or guidelines are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this document shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.    PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.