Calcium gluconate

Calcium gluconate

[$2.14 per vial]

ADMINISTRATION ROUTES:

  • IV

ALTERNATIVE NAMES:

  • Calcium gluconate

ICU INDICATIONS:

  1. Hypocalaemia (particularly if there is refractory shock or bleeding)
  2. ECG abnormalities caused by hyperkalemia (acts as a membrane stabiliser)
  3. Magnesium toxicity

PRESENTATION AND ADMINISTRATION:

  • IV:
    Preferably give via a central line (if this is present) Injection undiluted solution. 1g calcium gluconate/10ml (i.e. 10% solution); 2.2 mmol in 10 mL solution. Calcium gluconate is a clear colourless solution
    For direct IV injection, inject undiluted solution at a rate not exceeding 2ml/min
    For intermittent infusion, add 1gm of calcium gluconate to 50ml of compatible IV fluid and administer over 10 to 20 minutes.
    Compatible with the following IV fluids:
    D5W, normal saline, glucose and sodium chloride, Hartmanns
    Room temperature below 30°C

DOSAGE:

  • IV:
    Usually give one vial and repeat as necessary (note 1 vial of calcium gluconate contains approximately one third of the amount of calcium that is present in a vial of calcium chloride.)

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • 0.5ml/kg (max 20ml)

CLINICAL PHARMACOLOGY:

  • Calcium.

CONTRAINDICATIONS:

  • None

WARNINGS

  • Calcium gluconate should be injected into a large vein very slowly, as it may cause peripheral vasodilatation and a cutaneous burning sensation (it is preferable to administer it centrally if the patient has a central line) Avoid IV calcium in patients on digoxin where possible due to the risk of inducing digoxin toxicity.

PRECAUTIONS

  • General:
    Calcium gluconate injection, 10% is irritating to veins and must not be injected into tissues, since severe necrosis and sloughing may occur. Great care should be taken to avoid extravasation or accidental injection into perivascular tissues.
  • Laboratory Tests:
    An arterial or venous blood gas should be repeated after administration of calcium chloride to check the ionised calcium.
  • Drug/Laboratory Test Interactions:
    None known

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Hypercalcaemia increases the risk of digitalis toxicity. Because of the danger involved in the simultaneous use of calcium salts and drugs of the digitalis group, a digitalized patient should not receive intravenous injections of calcium unless the indications are clearly defined.

ADVERSE REACTIONS

  • The major side effects are those due to hypercalcaemia as a result of inadvertent over dosing.
  • Early:
    Weakness, headache, somnolence, nausea, vomiting, dry mouth, constipation, muscle pain, bone pain, metallic taste, and anorexia.
  • Late:
    Polyuria, polydipsia, anorexia, weight loss, nocturia, conjunctivitis (calcific), pancreatitis, photophobia, rhinorrhea, pruritus, hyperthermia, decreased libido, elevated Cr, albuminuria, hypercholesterolemia, elevated AST and ALT, ectopic calcification, nephrocalcinosis, hypertension, cardiac arrhythmias, dystrophy, sensory disturbances, dehydration, apathy, arrested growth, urinary tract infections, and, rarely, overt psychosis.

Critical Care Drug Manual

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