Department of Medicine, MTI, Khyber Teaching Hospital

Adult IV Medication Monograph

Calcium Gluconate 10%

Emergency tray medication – High risk medication

Drug Class Calcium supplement

Available dosage form Injection form - 10ml (Calcium Gluconate – 10%)

Usual Dosing Acute hypocalcaemia: 10-20ml (2.2-4.4mmol)

Fluoride or lead poisoning: 0.3ml/kg (0.07mmol/kg)
Cardiac resuscitation: 7-15ml (1.54-3.3mmol).
Dilution & Preparation Calcium Gluconate Injection can be diluted with glucose 5%
or sodium chloride 0.9%.

It should not be administered at dose more than 2ml/min

(10% calcium gluconate) .

For continuous intravenous infusion, dilute 100 mL of

calcium gluconate 10% in 1 litre of glucose 5% or sodium
chloride 0.9% and give at an initial rate of 50 mL/hour
adjusted according to response.
Administration Intravenous
Dosage adjustment Renal impairement: Use with caution.
Incompatibility Calcium salts can form complexes with many drugs like
amphotericin, ceftriaxone, dobutamine hydrochloride,
prochlorperazine, and tetracyclines.

Dilution into a solution containing bicarbonate, phosphate or

sulfate should be avoided.
Monitoring Monitoring should include heart rate or ECG.
Plasma levels and urinary excretion of calcium should
be monitored when high-dose parenteral calcium is
administered.
Contraindications & Contraindications:
Precautions Hypersensitivity
Patients with severe renal failure;
Patients with hypercalcaemia
Patients with hypercalciuria.
Patients receiving cardiac glycosides.
Co-administration with ceftriaxone.
Repeated or prolonged treatment, including as an
intravenous infusion, in those with impaired renal
function.
 Department of Medicine, MTI, Khyber Teaching Hospital
Adult IV Medication Monograph

Precautions:
In patients receiving ceftriaxone, it can be administered
sequentially one after another if infusion lines at
different sites are used to avoid precipitation.
Solutions containing calcium should be administered
slowly to minimise peripheral vasodilation and cardiac
depression.
Calcium salts are irritant. The infusion site must be
monitored regularly to ensure extravasation injury has
not occurred.
Patients receiving calcium salts should be monitored
carefully to ensure maintenance of correct calcium
balance without tissue deposition.
High Vitamin D intake should be avoided.
Combination with thiazide diuretics may induce
hypercalcaemia as these medicinal products reduce renal
calcium excretion.
Calcium may antagonise the effect of calcium
antagonists (calcium channel blockers).
Clinical considerations Hypocalcemic tetany
Cardiac resuscitation
Acute colic of lead poisoning
Acute fluoride poisoning
Prevention of hypocalcemia after mass transfusion/exchange
transfusion.
Adverse Effects Cardiovascular and other systemic undesirable effects are
likely to occur from intravenous overdose or too rapid
intravenous injection.
Cardiac disorders
Bradycardia, cardiac arrhythmia.
Hypotension, vasodilatation, circulatory collapse (possibly
fatal), flushing, mainly after too rapid injection.

Nausea, vomiting.

Heat sensations, sweating.

Calcinosis cutis, possibly followed by skin ablation and

necrosis. Reddening of skin, burning sensation or pain
during intravenous injection may indicate accidental
perivascular injection, which may lead to tissue necrosis.
Pregnancy Pregnancy
Department of Medicine, MTI, Khyber Teaching Hospital
Adult IV Medication Monograph

Calcium Gluconate Injection BP should not be used during

pregnancy unless clearly indicated.
The administered dose should be carefully calculated, and
the serum calcium level regularly evaluated in order to avoid
hypercalcaemia, which may be deleterious for the foetus.

Calcium is excreted in breast milk. A decision must be made

whether to discontinue breast-feeding or to
discontinue/abstain from Calcium Gluconate Injection BP
therapy taking into account the benefit of breast feeding for
the child and the benefit of therapy for the woman.