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|D5W, NS Calcium chloride link|
Standard Dilutions [Amount of drug] [Infusion volume] [Infusion rate]
|[1 to 4 grams] [50 - 100 ml] [See comments]*
*Dilutions assume peripheral line is used as well as D5W as the primary diluent (see comment section below - calculation of solution osmolarity).
^Actual infusion times should be based on serial calcium levels, severity of the deficit, current phosphate level (possible metastatic calcification), and the clinical presentation of the patient (acute versus chronic; symptoms present; etc.).
[The injection should be halted if the patient complains of any discomfort; it may be resumed when symptoms disappear. Following injection, the patient should remain recumbent for a short time. 2]
Calcium Gluconate: Maximum rate: 1.5 mL/minute = 0.7 meq/minute. 3
See monograph for general dosing.
Smaller volumes may be used in patients with a central line. Actual infusion rates should be based on the severity of the deficit. In non-emergent cases (asymptomatic patients), oral therapy is preferred.
-Serum calcium levels should be measured every 2 to 6 hours to guide continued therapy. If the patient has a low serum albumin level, ionized calcium should be monitored.
-The following patients need continuous ECG monitoring during calcium infusions: (1) Patient's with cardiac arrhythmias or (2) Patients receiving digoxin therapy.
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. The actual rate should be based on serial plasma calcium levels.
|1 gram= 4.65 meq (93 mg) 10 ml.
"Hypocalcemia is defined as a serum calcium concentration <8.5 mg/dL (or ionized calcium <4.2 mg/dL). Symptoms of hypocalcemia usually occur when ionized levels fall to <2.5 mg/dL. Symptoms include paresthesias of the extremities and face, followed by muscle cramps, carpopedal spasm, stridor, tetany, and seizures. Hypocalcemic patients show hyperreflexia and positive Chvostek and Trousseau signs. Cardiac effects include decreased myocardial contractility and heart failure." [Source].
Osmolarity calculations: source: https://globalrph.com/medcalcs/osmolarity-calculator-extremely-powerful-tool/
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.
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.
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.
Differentiation of hypoparathyroidism vs Vitamin D deficiency:
To avoid undesirable reactions that may follow rapid intravenous administration of calcium gluconate, the drug should be given slowly, e.g., approximately 1.5 mL over a period of one minute. When injected intravenously, calcium gulconate should be injected through a small needle into a large vein in order to avoid too rapid an increase in serum calcium and extravasation of calcium solution into the surrounding tissue with resultant necrosis.
Rapid injection of calcium gluconate may cause vasodilation, decreased blood pressure, bardycardia, cardiac arrhythmias, syncope and cardiac arrest.
Because of the danger involved in simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive an intravenous injection of a calcium compound unless indications are clearly defined.
Calcium complexes tetracycline antibiotics rendering them inactive. The two drugs should not be given at the same time orally nor should they be mixed for parenteral administration.
Calcium gluconate injection has been reported to be incompatible with intravenous solutions containing various drugs. Published data are too varied and/or limited to permit generalizations, and specialized reference should be consulted for specific information.
Rapid intravenous injection of calcium salts may cause vasodilation, decreased blood pressure, bardycardia, cardiac arrhythmias, syncope and cardiac arrest. Use in digitalized patients may precipitate arrhythmias.
Local necrosis and abscess formation may occur with intramuscular injection.
DOSAGE AND ADMINISTRATION
Children: 200-500 mg (2-5 mL)
Infants: not more than 200 mg (not more than 2 mL)
NDC 0517-3910-25 10% 10 mL Single Dose Vials 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).
[1 ] 2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Part 10.1: Life-Threatening Electrolyte Abnormalities. Circulation. 2005;112:IV-121-IV-125. Accessed - revisited: 05/01/11.