Page 124 - 2023 SMOG Digital

CALCIUM Gluconate Safe, Lactation Safe
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, arrhythmias); cardiac disturbances secondary to hyperkalemia; magnesium sulfate overdose;
massive transfusion prophylaxis
Unlabeled: Calcium channel blocker overdose; treatment of hydrofluoric acid exposure
Contraindications
• Ventricular fibrillation
• Hypercalcemia
• Concomitant use of IV calcium gluconate and ceftriaxone in neonates (risk of precipitation of calcium-
ceftriaxone)
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, vasodilation
o Do not exceed 200mg/min except in emergency situations
• Caution in patients receiving digoxin therapy, may cause arrhythmias
• Use small IV/Large Vein, flush prior and after, AVOID extravasation (will cause tissue necrosis)
o 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 chloride in the same I.V. line as phosphate-containing solutions.
• Precipitates with NaHCO3 in IV Bag/Tubing
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Cardiac arrest or cardiotoxicity in the presence of Cardiac arrest or cardiotoxicity in the presence
hyperkalemia, hypocalcemia, or hypermagnesemia: of hyperkalemia, hypocalcemia, or
IV/IO, SLOW hypermagnesemia:
• 1500-3000mg over 2-5 minutes IV/IO, SLOW
Calcium channel blocker overdose (off-label use): • 60-100mg/kg/dose (maximum: 3000mg/dose)
Hypotension/conduction disturbances:
IV/IO
• 3g (3000mg) over 5 minutes; may repeat Calcium channel blocker overdose (unlabeled
q10-20min with 3-4 additional doses. use): Hypotension/conduction disturbances:
IV/IO
Hypocalcemia prophylaxis from massive transfusion • 45mg/kg (maximum 3000mg/dose) over
• 30mL of 10% solution over 5 minutes 10-15min; may repeat q10-15min
Note: Calcium Chloride is 3X more potent than
Calcium Gluconate and therefore higher doses of
Calcium Gluconate must be used to reach similar Hypocalcemia prophylaxis from massive
therapeutic doses. transfusion
Hydrofluoric Acid Exposure – (off-label, see Burn SMOG) • 60mg/kg (maximum 30ml of 10% solution)
• Topical therapy: After thorough irrigation, a over 5 minutes
CaGlu gel (75mL KY Jelly + 25mL 10% CaGlu)
can be made and applied to the affected area,
left on for 30 minutes, cleaned off, and q4hr. Note: Calcium chloride may provide a more rapid
Assess for pain relief and monitor EKG increase of ionized calcium in critically ill children.
(NO Calcium Chloride!)

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