Calcium gluconate | 111

Calcium gluconate
10% solution in 10-mL ampoules
*
Calcium is the most abundant mineral in the body. It is required for bone and tooth formation and
is an essential electrolyte.
*
Normal range for plasma total calcium (‘corrected’ if necessary): 2.1--2.6 mmol/L.
*
Calcium gluconate injection is used to treat severe acute #Ca or tetany and to stabilise the
myocardium in severe "K.
*
Calcium gluconate injection is also used (unlicensed) in the treatment of patients with significant
clinical features of magnesium poisoning.
*
Calcium may be used parenterally in cardiac resuscitation (more usually in the form of calcium
chloride pre-filled syringes) if PEA is thought to be caused by "K or #Ca or in calcium channel
blocker overdose.
*
Intra-arterial calcium gluconate followed by hepatic venous sampling has been used to diagnose
insulinomas (unlicensed).
*
Because of the risk of aluminium exposure, calcium gluconate injection packed in small-volume
glass containers should not be used for repeated or prolonged treatment in children < 18 years or
in patients with renal impairment. Calcium gluconate injection packed in plastic containers may
be used.1

10% calcium gluconate injection contains: Ca2þ 225 micromol/mL (calcium 8.4 mg/mL).

This preparation must not be confused with calcium chloride injections, which have a markedly
different Ca2þ content.

Pre-treatment checks
*
Do not give to patients receiving cardiac glycosides.
*
Do not use for hypocalcaemia caused by renal impairment.
*
Do not use in conditions associated with hypercalcaemia and hypercalciuria (e.g. some forms of
malignant disease) and in severe renal impairment.
*
Caution in patients with mild to moderate renal impairment, cardiac disease, sarcoidosis,
respiratory acidosis or respiratory failure.

Biochemical and other tests (not all are necessary in an emergency situation)
Renal function: U, Cr, CrCl (or eGFR) ECG
Electrolytes: serum Ca Bodyweight (in certain indications)

Dose

Calcium salts are irritant and may cause tissue necrosis and sloughing if given IM or SC.
Calcium chloride is more irritant than calcium gluconate when given IV although both may
cause irritation and should be given with care to avoid extravasation.

Acute hypocalcaemia: 2.25 mmol (10 mL of 10% injection) by slow IV injection. In tetany this
should be followed by 9 mmol (40 mL of 10% injection) in 500 mL NaCl 0.9% or Gluc 5% by IV
infusion daily over 8--24 hours with frequent monitoring of serum Ca. Smaller volumes may be used
in fluid restriction.
112 | Calcium gluconate

An alternative regimen is to give 22.5 mmol Ca (100 mL of 10% injection) in 1 L of NaCl 0.9% or Gluc
5% solution by IV infusion at an initial rate of 50 mL/hour. Adjust the rate of infusion according to
4--6 hourly plasma Ca measurements.
Hyperkalaemia as part of overall treatment regimen (K > 6.5 mmol/L or if ECG changes
are present): give 10 mL calcium gluconate 10% by IV injection to stabilise cardiac muscle. Repeat
as necessary, dependent on ECG.
Cardiac resuscitation: calcium chloride injection is preferred (see the Calcium chloride
monograph).
Magnesium toxicity: it is essential to consult a poisons information service, e.g. Toxbase at www.
toxbase.org (password or registration required), for full details of the management of magnesium
toxicity.

Intravenous injection
Preparation and administration
1. Withdraw the required dose.
2. The solution should be clear and colourless. Inspect visually for particulate matter or discolor-
ation prior to administration and discard if present.
3. Give by slow IV injection (10 mL of 10% injection over a minimum of 3 minutes).

Intermittent or continuous intravenous infusion

Preparation and administration
1. Withdraw the required dose and add to a 500--1000 mL (see information above) NaCl 0.9% or
Gluc 5%. Mix well.
2. The solution should be clear and colourless. Inspect visually for particulate matter or discolor-
ation prior to administration and discard if present.
3. Give by IV infusion over 8--24 hours depending on the dosing regimen. Adjust dose and rate
according to serum Ca.
4. Prepare a fresh infusion bag at least every 24 hours.

Technical information

Incompatible with Bicarbonates, phosphates, tartrates and sulfates.

Amphotericin, dobutamine.

Compatible with Flush: NaCl 0.9%

Solutions: NaCl 0.9%, Gluc 5%, Gluc-NaCl, Hartmann’s
Y-site: No information

pH 6--8.2

Sodium content Nil

Osmolality (plasma osmolality Calcium gluconate 10% ffi 680 mOsmol/L.

¼ 280--300 mOsmol/L)2

Storage Store below 25 C in original packaging. Do not freeze.

Stability after preparation Use prepared infusions immediately.

 Calcium gluconate | 113

Monitoring

Measure Frequency Rationale

ECG During *
If using to treat "K.
administration

Serum Ca During therapy *

For signs of clinical improvement.
*
Monitor every 4--6 hours if giving by continuous infusion.

Blood pressure Periodically *

May #BP.

Injection site *
Injection-site reactions have occurred.

Additional information

Common and serious Injection/infusion-related:

undesirable effects
*
Too rapid administration: nausea, vomiting, hot flushes, sweating,
#BP and vasomotor collapse may occur.
*
Local: Irritation. Extravasation may cause tissue damage.

Pharmacokinetics After IV administration serum Ca will increase immediately and may return
to normal values in 30--120 minutes.

Significant interactions
*
The following may "calcium levels or effect (or "side-effects):
thiazides (#urinary Ca excretion).
*
Calcium gluconate may "levels or effect of the following drugs
(or "side-effects):
digoxin, digitoxin.

Action in case of overdose Overdose can lead to "Ca. Treat initially with IV infusion of NaCl 0.9%.

Risk rating: AMBER Score ¼ 3

Moderate-risk product: Risk-reduction strategies are recommended.

This assessment is based on the full range of preparation and administration options described in the
monograph. These may not all be applicable in some clinical situations.

Reference
1. MHRA. Calcium gluconate injection in small-volume glass containers: new contraindications due
to aluminium exposure risk. Drug Safety Update: Volume 4, Issue 1, August 2010.
2. Longmore M et al., eds. Oxford Handbook of Clinical Medicine, 6th edn. Oxford: Oxford University
Press, 2004.

Bibliography
SPC Calcium Gluconate Injection BP, Hameln (accessed 30 March 2010).
SPC Calcium Gluconate Injection BP, Goldshield (accessed 30 March 2010).