CALCIUM GLUCONATE IN SODIUM CHLORIDE
Clinical safety rating
safeNo significant drug interactions Can cause hypernatremia and fluid overload.
Calcium gluconate provides calcium ions, which are essential for normal cardiac function, nerve transmission, and muscle contraction. In hyperkalemia, calcium antagonizes the cardiotoxic effects of potassium by stabilizing the cardiac cell membrane.
| Metabolism | Not metabolized; calcium is excreted primarily in urine and feces. |
| Excretion | Primarily renal; ~80% of administered calcium is excreted in urine via glomerular filtration with tubular reabsorption; fecal excretion accounts for ~15-20% as unabsorbed or secreted calcium; negligible biliary excretion. |
| Half-life | Terminal elimination half-life is 6-8 hours in patients with normal renal function; prolonged in renal impairment (up to 24-48 hours). |
| Protein binding | Approximately 45-50% bound to albumin; also binds to globulins and other proteins. |
| Volume of Distribution | 0.15-0.25 L/kg; reflects distribution primarily in extracellular fluid; increases in conditions with increased capillary permeability. |
| Bioavailability | Intravenous: 100% (complete systemic availability); not administered orally for systemic effect due to poor bioavailability; calcium gluconate oral absorption is ~30% but not relevant for this formulation. |
| Onset of Action | Intravenous: immediate (within 1-2 minutes); Intramuscular: not recommended due to irritation; Oral: not applicable (IV formulation). |
| Duration of Action | Intravenous: 30 minutes to 2 hours for serum calcium elevation; clinical effect on myocardial contractility and neuromuscular excitability persists for 1-4 hours after bolus. |
| Molecular Weight | 430.37 Da (calcium gluconate as the monohydrate: Ca(C6H11O7)2·H2O; anhydrous: 430.37 Da) |
1-2 g calcium gluconate (9.3-18.6 mEq calcium) intravenously over 10-20 minutes, may repeat if needed. For continuous infusion: 0.5-2 mg/kg/hour calcium gluconate. Max rate: 1-2 mL/minute of 10% solution.
| Dosage form | SOLUTION |
| Renal impairment | No specific dose reduction required; monitor serum calcium and phosphate levels. In severe renal impairment (CrCl <30 mL/min), use with caution due to risk of calcium loading and soft tissue calcification. |
| Liver impairment | No dose adjustment required for hepatic impairment. Calcium gluconate is not hepatically metabolized. |
| Pediatric use | Neonates and infants: 200-500 mg/kg/day intravenously as a continuous infusion or in divided doses. Children: 500-1000 mg/kg/day intravenously; maximum single dose 1 g. Administer slowly (not exceeding 0.5-1 mL/min of 10% solution). |
| Geriatric use | No specific dose adjustment; administer at lower end of dosing range due to potential renal impairment. Monitor serum calcium, magnesium, and phosphate levels regularly. Infuse at a slower rate (e.g., over 20-30 minutes per gram). |
| 1st trimester | Calcium gluconate is generally considered safe during the first trimester when used for approved indications such as hypocalcemia. Fetal development of the skeletal system requires calcium; supplementation may be beneficial if maternal deficiency exists. However, use only when clearly needed and monitor serum calcium levels to avoid hypercalcemia, which could be harmful. |
| 2nd trimester | Safe for use during the second trimester for maternal hypocalcemia. Ensure adequate but not excessive calcium to support fetal skeletal mineralization. Avoid hypercalcemia as it may lead to placental calcification and fetal harm. |
| 3rd trimester | Safe during the third trimester for managing hypocalcemia, especially in preeclampsia or preterm labor. Excessive calcium may suppress parathyroid hormone in the neonate leading to hypocalcemia. Monitor maternal and neonatal calcium levels. |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Placental transfer | Calcium crosses the placenta via active transport. Approximately 80% of calcium is transferred to the fetus during the third trimester. Administration of calcium gluconate results in increased maternal serum calcium, which enhances placental transfer. The fetus regulates calcium via parathyroid hormone-related protein. |
| Breastfeeding | Calcium gluconate is excreted into human breast milk in small amounts. It is considered compatible with breastfeeding. Milk calcium levels may increase transiently but are unlikely to affect the infant. However, avoid maternal hypercalcemia as it can suppress neonatal parathyroid hormone and cause hypocalcemia. Monitor infant for signs of hypercalcemia if mother receives high doses. |
| Lactation Rating | L2 (Safer) or Safe |
| Teratogenic Risk | Calcium gluconate is a physiologic ion. No teratogenic effects are reported at therapeutic doses. Maternal calcium requirements increase during pregnancy, but exogenous calcium administration at standard doses is not associated with fetal malformations. However, maternal hypercalcemia (e.g., from excessive dosing) can lead to fetal hypoparathyroidism, hypotonia, and polyhydramnios, particularly in the third trimester. |
| Fetal Monitoring | Monitor maternal serum calcium, phosphate, magnesium, and renal function periodically, especially with prolonged therapy. Assess for signs of hypercalcemia (nausea, vomiting, confusion, QT interval shortening on ECG). For fetal monitoring, assess for polyhydramnios if maternal calcium levels exceed normal range. In neonates, monitor for hypocalcemia if maternal hypercalcemia occurred near delivery. |
| Fertility Effects | No known adverse effects on fertility at therapeutic doses. Calcium is essential for oocyte maturation and sperm function; deficiency may impair fertility, but supplementation at standard doses does not enhance or impair reproductive function in normocalcemic individuals. |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | fluid replacement |
| Serious Effects |
HypercalcemiaHypercalciuriaSevere renal failure (oliguric anuria)Digitalis toxicity (due to risk of cardiac arrhythmias from rapid calcium administration)Known hypersensitivity to calcium gluconate or any component
| Precautions | Risk of cardiac arrest or arrhythmia if administered too rapidly intravenously, Extravasation may cause tissue necrosis or sloughing, Use with caution in patients with renal impairment due to risk of hypercalcemia, May cause hypercalcemia; monitor calcium levels, Avoid in patients with digitalis toxicity due to risk of fatal arrhythmias |
| Food/Dietary | No significant food interactions, but avoid excessive dietary calcium intake (e.g., dairy, fortified foods) during therapy to prevent hypercalcemia. Caffeine and alcohol may affect calcium levels; limit intake. |
| Clinical Pearls | Calcium gluconate in sodium chloride (0.9% NaCl) is used for intravenous calcium replacement. It provides 0.465 mEq of calcium per mL (9.3 mg elemental calcium per mL). Infiltration causes severe tissue necrosis; use a central line if peripheral access is poor. Do not mix with bicarbonate, phosphate, or sulfate containing solutions (precipitates). Monitor ECG during infusion for bradycardia or arrhythmias. In cardiac arrest due to hyperkalemia or calcium channel blocker overdose, give 1 g IV push over 2-5 minutes with ECG monitoring. Extravasation: treat with hyaluronidase injection and warm compresses. |
| Patient Advice | Report any pain, redness, or swelling at the IV site immediately. · Inform your doctor if you have kidney stones, kidney disease, or sarcoidosis. · Avoid taking calcium supplements or vitamin D without doctor approval. · Do not consume large amounts of dairy products, antacids, or calcium-fortified foods unless directed. · This medication may cause a warm sensation, metallic taste, or flushing during infusion; tell your nurse if these occur. |
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