calcium gluconate

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

calcium gluconate

Indication

  • Treatment of neonatal hypocalcemia 
  • Treatment of symptomatic hyperkalemia

Dosage Guidelines

  • Hypocalcemia:
    • Initial: 50-100 mg/kg/dose IV
      Maintenance: 50-200 mg/kg/dose IV q6 hours or 8-30 mg/kg/hr IV continuous
  • Hyperkalemia: 50 mg/kg/dose IV (over 5-10 minutes)

Administration

  • SLOW IV direct by MD/NP or under direct supervision by MD/NP not to exceed 100 mg/minute
  • IV intermittent slow infusion over 30 minutes
  • IV continuous infusion

To make 50 mL of a 20 mg/mL solution:

  1. Draw up 10 mL of calcium gluconate 100 mg/mL in a 50 mL syringe
  2. Add 40 mL of either D5W or NS to make a final volume of 50 mL of a 20 mg/mL solution
  • Administer at a rate not exceeding 100 mg/min (5 mL/min of the 20 mg/mL concentration)
  • Central Line preferred
  • Avoid scalp veins and ensure line patency

Adverse Effects

  • Severe necrosis and tissue sloughing may occur due to extravasation
  • Hypercalcemia and cardiac arrhythmias or arrest with rapid bolus infusion

Comments

  • Monitor for bradycardia and arrythmias when giving IV bolus
  • Incompatible with many medications including sodium bicarbonate (because of precipitation); consult Pharmacist for compatibility with other medications
  • Avoid extravasation: for calcium burns consider using hyaluronidase

Supplied As

1 g vial (100 mg/mL) 
20 mg/mL IV syringe prepared by Pharmacy

At LHSC, standard concentration reference charts are available on the NICU Intranet site

References

LexiComp Sick Kids, LexiComp Pediatric and Neonatal, Neofax