Calcium gluconate
(calcium salt)
What it isCalcium-repletion salt; hypocalcemia and cardiac membrane stabilization in severe hyperkalemia.
Why this oneIt is less caustic than calcium chloride, making peripheral administration safer when central access is unavailable.
What limits itLess elemental calcium per gram means larger or repeated doses when the deficit is real; extravasation can still injure tissue, and bicarbonate or phosphate are incompatible.
FDA label
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| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Acute symptomatic hypocalcemia — IV bolus | Adults | 1,000-2,000 mg IV bolus | Repeat q6h if needed | Bolus rate not to exceed 200 mg/min |
| Acute symptomatic hypocalcemia — continuous IV infusion | Adults | Initiate at 5.4-21.5 mg/kg/hr | Adjust rate per serum calcium | |
| Acute symptomatic hypocalcemia — IV bolus | Pediatric (>1 mo to <17 yr) | 29-60 mg/kg IV bolus | Repeat q6h if needed | Bolus rate not to exceed 100 mg/min |
| Acute symptomatic hypocalcemia — continuous IV infusion | Pediatric (>1 mo to <17 yr) | Initiate at 8-13 mg/kg/hr | Adjust rate per serum calcium | |
| Acute symptomatic hypocalcemia — IV bolus | Neonate (<=1 mo) | 100-200 mg/kg IV bolus | Repeat q6h if needed | Bolus rate not to exceed 100 mg/min |
| Acute symptomatic hypocalcemia — continuous IV infusion | Neonate (<=1 mo) | Initiate at 17-33 mg/kg/hr | Adjust rate per serum calcium |
Renal Initiate at the lowest dose of the recommended range (all ages); monitor serum calcium every 4 hours
Hepatic Dose adjustment may not be necessary — hepatic function does not impact availability of ionized calcium after IV administration
Measure serum calcium q4-6h during intermittent infusions and q1-4h during continuous infusion
Instructions
- Dilute before use in D5W or NS: bolus to 10-50 mg/mL; continuous infusion to 5.8-10 mg/mL; use diluted solution immediately
- Administer via secure IV line (avoid extravasation — calcinosis cutis/tissue necrosis); infuse slowly with ECG monitoring
- Do not mix with ceftriaxone, minocycline, or fluids containing phosphate or bicarbonate (precipitation)
- 100 mg/mL solution provides 9.3 mg (0.465 mEq) elemental calcium per mL
Available strengths
- inj 100 mg/mL
Contraindications
- Hypercalcemia
- Neonates (28 days of age or younger) receiving ceftriaxone (fatal ceftriaxone-calcium precipitates)
Cautions
- Arrhythmias with cardiac glycosides — avoid; if unavoidable, give slowly in small amounts with close ECG monitoring
- Ceftriaxone-calcium precipitates: contraindicated in neonates; in older patients give sequentially with line flush — never simultaneously via Y-site
- Tissue necrosis and calcinosis cutis (with or without extravasation) — stop infusion at site if it occurs
- Rapid injection: vasodilation, hypotension, bradycardia, arrhythmias, syncope, cardiac arrest
- Aluminum content up to 400 mcg/L — toxicity risk with prolonged use in renal impairment and premature neonates
Adverse reactions
- Local soft-tissue inflammation/necrosis, calcinosis cutis, calcification (extravasation) — most common
- Vasodilation, hypotension, bradycardia, arrhythmia, syncope, cardiac arrest
Pregnancy Limited data insufficient to inform drug-associated risk; untreated maternal hypocalcemia itself risks spontaneous abortion, premature/dysfunctional labor, preeclampsia, and neonatal hyperparathyroidism
Lactation Calcium is a natural component of human milk; unknown whether IV calcium gluconate alters milk calcium; weigh benefits of breastfeeding against maternal need
NO BOXED WARNINGS
Principal riskArrhythmia with digoxin; hypotension and bradycardia with rapid injection