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- Calcium therapy
- Antidote to magnesium sulfate
- Severe hypocalcaemia
- Magnesium sulfate intoxication
Forms and strengths, route of administration
- 1 g ampoule (100 mg/ml, 10 ml; 10% solution) for slow IV injection or infusion in 5% glucose or 0.9% sodium chloride or Ringer lactate
- For slow IV injection in children, dilute 1 part of calcium gluconate to 4 parts of diluent (i.e. 1 ml of calcium gluconate to 4 ml of diluent), however it may be administered undiluted in emergencies.
- For continuous infusion:
- The calcium concentration in the infusion fluid should not exceed 50 mg/ml.
- Mix thoroughly the calcium and the infusion fluid by inverting at least 5 times the infusion bottle or bag.
- NEVER USE BY IM OR SC INJECTION.
- Neonate and child under 20 kg: 0.5 ml/kg (max. 10 ml) by slow IV injection (over at least 5 minutes) then 2 to 4 ml/kg (max. 40 ml) in a 100 ml bottle or bag by continuous infusion over 24 hours
- Child 20 kg and over and adult: 10 ml by slow IV injection (over at least 5 minutes) then 40 ml in a 250 ml or 500 ml bottle or bag by continuous infusion over 24 hours
Magnesium sulfate intoxication
- Child under 20 kg: 0.5 ml/kg (max. 10 ml) by slow IV injection (over at least 5 minutes)
- Child 20 kg and over and adult: 10 ml by slow IV injection (over at least 5 minutes)
- According to clinical response and plasma-calcium levels.
- For hypocalcaemia, change to oral route as soon as possible.
Contra-indications, adverse effects, precautions
- Do not administer to patients with severe renal disease or patients receiving cardiac glycosides.
- Do not administer ceftriaxone to neonates receiving calcium gluconate (risk of precipitation of ceftriaxone-calcium salts in lungs and kidneys).
- May cause:
- tingling sensations, warm flushes, dizziness;
- tissue necrosis in the event of extravasation;
- hypercalcaemia in the event of too rapid IV injection or overtreatment. First signs of hypercalcaemia include nausea, vomiting, thirst and polyuria. In severe cases, risk of hypotension, bradycardia, arrhythmia, syncope and cardiac arrest.
- Hypercalcaemia can be confirmed by monitoring of serum-calcium levels and ECG changes. Do not use in prolonged treatment if plasma-calcium levels cannot be monitored.
- The patient should be placed in the horizontal position prior to injection and should remain lying down for 30 to 60 minutes.
- Pregnancy and breast-feeding: no contra-indication
- Calcium gluconate is also administered as adjunctive therapy in insect bites or stings (black widow spider, scorpions) for the management of muscle pain and spasms. Several doses at 4-h intervals may be necessary.
- 1 g of calcium gluconate (2.2 mmol or 4.5 mEq) is equivalent to 89 mg of calcium.
- Calcium gluconate is incompatible with many drugs: do not mix with other drugs in the same syringe or infusion fluid. Flush the IV line thoroughly between infusions, especially in patients receiving ceftriaxone, cefazolin, amphotericin B and sodium bicarbonate.
- Do not use if the solution appears cloudy or particles are visible (calcium gluconate precipitate).
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