– Calcium therapy
– Antidote to magnesium sulfate
– Severe hypocalcaemia (hypocalcaemic tetany, neonatal hypocalcaemia, etc.)
– Symptomatic hypermagnesaemia due to excessive doses of magnesium sulfate
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
Also comes in 5 g ampoule (100 mg/ml, 50 ml), 10 g vial (100 mg/ml, 100 ml), 20 g vial (100 mg/ml, 200 ml).
– Severe hypocalcaemia
Neonate: 2 ml/kg of a 10% solution by IV infusion over 30 minutes followed by 4 ml/kg of a 10% solution administered by continuous infusion over 24 hours
Adult: 10 ml by slow IV injection (over at least 5 minutes), either repeated as required, or followed by continuous infusion of 40 ml of a 10% solution over 24 hours
Change to oral route as soon as possible.
– Magnesium sulfate intoxication
Adult: 10 ml of a 10% solution by slow IV injection (over at least 5 minutes), to be repeated once if necessary
– According to clinical response and plasma-calcium levels
Contra-indications, adverse effects, precautions
– Do not administer to patients with severe renal disease or patients receiving cardiac glycosides.
– Do not administer by IM or SC route (pain and risk of tissue necrosis or abscess formation at injection site, especially in infants and children).
– 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, hypo tension, bradycardia, arrhythmia, syncope and cardiac arrest may develop.
– 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: no contra-indication
– 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.
– Do not use if the solution appears cloudy or particles are visible (calcium gluconate precipitate).
– Storage: below 25 °C -