Calcium Gluconate

Calcium gluconate is the calcium salt of gluconic acid, an intravenous medication used to treat conditions arising from calcium deficiencies such as hypocalcemic tetany, hypocalcemia related to hypoparathyrodism, and hypocalcemia due to rapid growth or pregnancy.

• Calcium gluconate is available under the following different brand names: Gluconate and Ca.

Dosage Forms and Strengths

Injectable solution

• 100mg/mL (10%)

Tablet

• 50mg
• 500mg
• 650mg

Capsule (adult only)

• 500mg

Calcium Supplementation

• Adults 19-50 years old: 1000 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Adults over 50 years old: 1200 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Pregnant or breastfeeding patient: 1000/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Children 9-18 years old: 1300 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Children 4-8 years old: 800 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Children 1-3 years old: 500 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Infants 7-12 months old: 270 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals
• Infants 0-6 months old: 210 mg/day orally divided every 8-12 hours, preferably 1-2 hours after meals

Dosing Considerations

• Dietary reference intakes are expressed as elemental calcium

Hypocalcemia

Treatment of conditions arising from calcium deficiency (e.g., hypocalcemic tetany, hypoparathyroidism)

Mild (ionized calcium 1-1.2 mmol/L)

• Management of non-life-threatening symptoms
• Adult, oral: 1-3 g/day in divided doses; oral repletion may be considered and administered on an outpatient basis
• Adult, intravenous (IV): 1-2 g over 2 hours
• Neonates: 500-1500 mg/kg/day orally divided every 4-6 hours
• Infants/children: 500-725 mg/kg/day orally divided every 6-8 hours

Severe (ionized calcium less than 1 mmol/L)

• Adult, without seizure or tetany: 0.5 mg/kg/hour intravenously (IV); may be increased to 2 mg/kg/hour; not to exceed 3-4 g IV over 4 hours
• Adult, monitor serum calcium every 4-6 hours to maintain serum calcium levels
• Neonates: 200-800 mg/kg/day IV by continuous infusion or divided every 6 hours as intermittent infusions
• Infants/children: 200-500 mg/kg/day IV by continuous infusion or divided every 6 hours as intermittent infusions

Hypocalcemic tetany

• Adult: 100-300 mg elemental calcium (approximately 3 g calcium gluconate) intravenously (IV) over 5-10 minutes, followed by continuous IV infusion at 0.5 mg/kg/hour (may be increased to 2 mg/kg/hour)
• Pediatric: 100-200 mg/kg IV over 10 minutes; may be repeated after 6 hours, or initiate continuous infusion not to exceed 500 mg/kg/day

• Management of cardiac arrest only in presence of hyperkalemia, hypocalcemia, or hypermagnesemia (routine use for cardiac arrest not recommended, because it yields no improvement in survival)
• 1.5-3 g intravenously (IV) over 2-5 minutes

• Topical: Use 2.5% gel, placing in glove to apply to hand; if gel unavailable, prepare with 10% calcium gluconate solution in 3 times volume of KY gel
• Subcutaneous: 10% calcium gluconate, no more than 0.5 mL/cm² of skin; do not use in digits
• If topical and/or subcutaneous do not work, consider intra-arterial
• Intra-arterial calcium infusion for moderate to severe burns: Infuse 10 mL 10% calcium gluconate mixed with 40-50 mL D5W over 4 hours, repeating as needed (need to indicate with high-pressure pump)

• 60-120 mg/kg/hour intravenously (IV) or 60 mg/kg IV over 5 minutes every 10-20 minutes as needed up to 3-4 doses; not to exceed 3-4 g/dose

• 1.5-3 g intravenously (IV) infused over 2-5 minutes

Hypermagnesemia (Off-label)

• 1.5-3 g intravenously (IV) infused over 2-5 minutes

Side effects of Calcium Gluconate include:

• Chalky taste following intravenous administration
• Constipation
• Decreased appetite
• Diarrhea
• Dry mouth
• Extravasation necrosis
• Gas (flatulence)
• Headache
• Hot flashes
• Increased thirst
• Increased urination
• Low blood magnesium (hypomagnesemia)
• Low blood phosphates (hypophosphatemia)
• Low blood pressure (hypotension)
• Nausea
• Slow heart rate
• Tingling sensations
• Vomiting

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider, or pharmacist first.

• Severe interactions of calcium gluconate include:
• ceftriaxone
• Serious interactions of calcium gluconate include:
  • demeclocycline
  • dolutegravir
  • doxycycline
  • eltrombopag
  • lymecycline
  • minocycline
  • oxytetracycline
  • tetracycline
• Calcium gluconate has moderate interactions with at least 50 different drugs.
• Calcium gluconate has mild interactions with at least 52 different drugs.

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

• This medication contains calcium gluconate. Do not take Gluconate or Ca if you are allergic to calcium gluconate or any ingredients contained in this drug.
• Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

• Hypersensitivity
• Intramuscular/subcutaneous (IM/SC) administration
• Ventricular fibrillation during CPR
• High blood calcium (hypercalcemia)
• Digoxin poisonings
• Sarcoidosis

Effects of Drug Abuse

• No information available

Short-Term Effects

• No information available
• See "What Are Side Effects Associated with Using Calcium Gluconate?"

Long-Term Effects

• No information available
• See "What Are Side Effects Associated with Using Calcium Gluconate?"

Cautions

• Hepatic or renal impairment, cardiovascular disease, acidosis, history of renal calculi.
• Cardiac arrest may occur.
• Constipation, bloating, and gas may occur with oral administration.
• Use caution in patients with severe hyperphosphatemia.
• Adult and Pediatric Advanced Life Support programs no longer recommend routine calcium for CPR.
• Rapid intravenous (IV) infusion associated with low blood pressure (hypotension), slow heart rate (bradycardia), fainting (syncope), cardiac arrest, cardiac arrhythmias, sense of oppression, or heat waves, tingling sensation, vasodilation.

Pregnancy and Lactation

• Use calcium gluconate with caution during pregnancy if the benefits outweigh the risks. Animal studies show risk and human studies are not available or neither animal nor human studies were done.
• Calcium gluconate enters human milk; use caution if breastfeeding.