Calcium Gluconate Injection is a form of calcium indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia.
DOSAGE AND ADMINISTRATION:
- Contains 100 mg of calcium gluconate per mL which contains 9.3 mg (0.465 mEq) of elemental calcium.
- Individualize the dose within the recommended range in adults and pediatric patients depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia.
MONITORING:
- Measure serum calcium during intermittent infusions every 4 to 6 hours and during continuous infusion every 1 to 4 hours.
CONTRAINDICATIONS:
- Hypercalcemia
- Neonates (28 days of age or younger) receiving ceftriaxone
WARNINGS AND PRECAUTIONS:
- Arrhythmias with Concomitant Cardiac Glycoside Use: If concomitant therapy is necessary, Calcium Gluconate Injection should be given slowly in small amounts and close ECG monitoring is recommended.
- End-Organ Damage due to Intravascular Ceftriaxone-Calcium Precipitates: Concurrent use of intravenous ceftriaxone may cause life-threatening precipitates. Cases of fatal outcomes in neonates have occurred.
- Tissue Necrosis and Calcinosis: Calcinosis cutis can occur with or without extravasation of Calcium Gluconate Injection. Tissue necrosis, ulceration, and secondary infection are the most serious complications. If extravasation occurs or clinical manifestations of calcinosis cutis are noted, immediately discontinue intravenous administration at that site and treat as needed.
- Hypotension, Bradycardia, and Cardiac Arrhythmias with Rapid Administration: To avoid adverse reactions that may follow rapid intravenous administration, Calcium Gluconate Injection should be diluted with 5% dextrose or normal saline and infused slowly, with careful ECG monitoring for cardiac arrhythmias.
- Aluminum Toxicity: This product contains aluminum, up to 512 mcg per liter, that may be toxic.
ADVERSE REACTIONS:
- The most common adverse events with Calcium Gluconate Injection are local soft tissue inflammation and necrosis, calcinosis cutis and calcification that are related to extravasation. Other adverse events include vasodilation, decreased blood pressure, bradycardia, cardiac arrhythmia, syncope, and cardiac arrest.
USE IN SPECIFIC POPULATIONS:
- Geriatric use: Dosing in elderly patients should be cautious, usually starting at the low end of the dosage range.
- Renal impairment: Initiate with the lower limit of the dosage range and monitor serum calcium levels every 4 hours.
NOTES:
- Calcium Gluconate Injection is not physically compatible with fluids containing phosphate or bicarbonate. Precipitation may result if mixed.
- The safety of Calcium Gluconate Injection for long term use has not been established.
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Resource Person: Lobna Adi (Clinical Pharmacist)