CALCIUM GLUCONATE IN SODIUM CHLORIDE
Clinical safety rating: safe
No 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. |
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 | Consult provider |
| 2nd trimester | Consult provider |
| 3rd trimester | Consult provider |
Clinical note
No significant drug interactions Can cause hypernatremia and fluid overload.
| FDA category | Animal |
| Breastfeeding | Calcium is a normal constituent of breast milk. Exogenous calcium gluconate administration increases maternal serum calcium transiently, but the effect on milk calcium concentration is minimal. The milk-to-plasma (M/P) ratio for calcium is approximately 0.1–0.3, indicating limited transfer. Use in breastfeeding mothers is considered compatible with breastfeeding when doses are within standard therapeutic ranges. |
| Teratogenic Risk |
■ FDA Black Box Warning
No FDA boxed warning.
| Common Effects | fluid replacement |
| Serious Effects |
["Hypercalcemia","Severe hypercalciuria","Patients receiving digitalis (toxicity risk)","Known hypersensitivity to calcium gluconate or any component of the formulation"]
| 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. |
Loading safety data…
| 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. |
| 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. |