Page 107 - 2026 SMOG

CALCIUM GLUCONATE (CaGlu)
Class/Mechanism of Action
• Calcium Salt, Electrolyte Supplement
Moderates nerve and muscle contractility via regulation of action potential excitation threshold.
Indications
• Labeled Indications
˚ Treatment of hypocalcemia and conditions secondary to hypocalcemia (e.g., tetany, seizures,
arrhythmia); cardiac disturbances secondary to hyperkalemia; treatment of magnesium
sulfate toxicity (hypermagnesemia); massive transfusion prophylaxis
• Off-Label Indications
˚ Calcium channel blocker toxicity; treatment of hydrofluoric acid exposure
Contraindications
• Ventricular fibrillation
• Hypercalcemia
• In neonates receiving ceftriaxone, it may cause intravascular ceftriaxone-calcium precipitates
with resulting endorgan damage. If using in children >28 days on concomitant ceftriaxone,
do not administer simultaneously through the same IV line or connector; may administer
sequentially through the same line with thorough flushing.
Adverse Reactions/Precautions
• Hypokalemia: Use with caution in patients with severe hypokalemia. Acute rises in calcium can
cause life-threatening arrhythmias.
• Rapid push can cause arrhythmia, bradycardia, cardiac arrest, hypotension, syncope, and
vasodilation.
• Do not exceed 200mg/min except in emergencies
• Caution in patients receiving digoxin therapy; may cause arrhythmia
• Use small IV/large vein; flush prior to and after. AVOID extravasation (will cause tissue
necrosis)
˚ In general, IV Calcium Gluconate is preferred over IV Calcium Chloride in nonemergency
settings due to the potential for extravasation with Calcium Chloride
• Do not infuse Calcium Gluconate in the same IV line as phosphate-containing solutions
• Precipitates with Sodium Bicarbonate in IV bag/tubing
• Avoid in patients receiving cardiac glycosides; may cause cardiac arrhythmias
• Pregnancy: Safe
• Lactation: Present in breast milk
(continues)

2026 Standard Medical Operating Guidelines (SMOG) • 99