Calcium gluconate 10%w/v

Dosage:

Over one month:

Hypocalcaemia – urgent correction, hyperkalaemia (prevention of arrythmias): 0.11mmol/kg IV over 5-10 minutes. Max. 4.5mmol. 
In treatment of hyperkalaemia see also CHI Acute Management of Hyperkalaemia Guideline

Hypocalcaemia – maintenance: 1mmol/kg/day by continuous IV Infusion. Usual max. 8.8mmol over 24 hours.  Adjust according to plasma calcium.

Note: 0.11 mmol/kg is equivalent to 0.5 mL/kg of calcium gluconate 10% w/v.

Contraindications: Hypercalcaemia, severe hypercalciuria, severe renal failure and in patients receiving cardiac glycosides.

Cautions: Sarcoidosis, history of nephrolithiasis

Renal impairment: Use with caution

Monitoring:

Monitor serum calcium

For urgent correction of hypocalcaemia, and treatment of hyperkalaemia, cardiac monitoring is required – too rapid administration may cause arrhythmias.

Administration:

Note: Switch to oral calcium as soon as possible

Intravenous: Available as Calcium Gluconate Injection 10% w/v miniplasco (= calcium 0.225mmol/mL). Please note: Different preparations may have negligible concentration differences (0.22-0.23mmol/mL)

Compatible infusion fluids: Sodium Chloride 0.9% w/v or Glucose 5% w/v

Method of administration: Slow IV bolus or continuous infusion as detailed below:

• Slow IV injection (bolus) over 5 - 10minutes. Administer in accordance with the CHI Smart-pump drug library (Table 1: Non continuous / bolus dosing). ECG monitoring required. 
  May be used undiluted (10% w/v calcium gluconate) in emergencies under consultant advisement. 

• Continuous intravenous infusion - Administer in accordance with the CHI Smart-pump Standard Concentration Infusion (SCI) drug library (Table 2: Continuous Infusion) below.
  Usual maximum rate of infusion:
  • For neonates: 0.5mmoL/kg/24hours
  • For children ≥1month: 1mmoL/kg/24hours 

Avoid extravasation as calcium salts cause tissue necrosis (high osmolality), use central venous access device if available. If giving peripherally, use a large vein and monitor insertion site closely. 

Interactions:

Large intravenous doses of calcium salts can precipitate arrhythmias when given with cardiac glycosides.

Adverse Effects:

Side effects include bradycardia, arrhythmias, peripheral vasodilatation, fall in blood pressure, sweating, injection-site reactions, GI disturbances, severe tissue damage with extravasation.

Preparations:

Calcium Gluconate Injection 10% w/v miniplasco (unlicensed)
Negligible differences in concentration may occur with different preparations (0.225-0.226mmol/mL)