Intravenous Antidote in severe hypermagnesaemia, Severe hyperkalaemia
Adult: As 10% solution: 10-20 mL (2.25-4.5 mmol Ca), may repeat dose as necessary according to patient response. Subsequent doses in hyperkalaemia may be done under ECG control.
Intravenous Hypocalcaemic tetany
Adult: As 10% solution: Initially, 10-20 mL (2.25-4.5 mmol Ca) via slow inj may repeat dose as required or followed by continuous infusion to prevent recurrence. Max rate: 2 mL/min (0.45 mmol Ca/min). Child: Neonates: 1-2 mL/kg over approx 10-20 minutes, followed by 0.5-1 g/kg/day via continuous infusion over 1-2 days.
Intravenous Hypocalcaemia
Adult: As 10% solution: In acute cases: Usual dose: Initially, 10 mL (2.25 mmol or 4.5 mEq Ca), may repeat dose as necessary depending on the clinical condition of the patient. As prevention during transfusion: 10 mL diluted in 100 mL 5% dextrose in water given over 10 minutes. Alternatively, 10-20 mL for each 500 mL of blood infused. Max rate: 2 mL/min (0.45 mmol Ca/min). Child: As prevention during massive blood transfusion: 100-200 mg/kg (1-2 mL/kg) over 5-10 minutes. Max rate of 5 mL/min. Dose may be individualised according to the type and severity of the condition (refer to detailed product guideline).
Oral Hypocalcaemia
Adult: As effervescent tab: Usual dose: 10-50 mmol (0.4-2 g) Ca daily. Dosage may be individualised according to patient need. Child: May require half of the usual adult dose.
Reconstitution
Dilute solution in 5% dextrose or 0.9% NaCl to a concentration of 10-50 mg/mL (bolus inj) or 5.8-10 mg/mL (infusion).
Patients with hypercalcaemia or conditions associated with hypercalcaemia (e.g. hyperparathyroidism, hypervitaminosis D, neoplastic disease with bone decalcification, immobilisation osteoporosis), hypercalciuria, severe renal failure. IV: Concomitant use with ceftriaxone in premature (up to corrected age of 41 weeks [weeks of gestation and life]) or full-term neonates (≤28 days of age).
Special Precautions
Patients with cardiac impairment, nephrocalcinosis, sarcoidosis (Boeck’s disease), severe hypokalaemia, hypomagnesemia, Ca renal calculi or history of renal calculi, calculi formation in the urinary tract, severe hyperphosphatemia. Renal impairment. Children. Pregnancy and lactation. Patients receiving cardiac glycosides.
Adverse Reactions
Significant: Bradycardia with vasodilatation or arrhythmia. Gastrointestinal disorders: Gastrointestinal irritation, nausea, vomiting, chalky taste. General disorders and administration site conditions: Soft tissue calcification, heat sensations, sweating, local tissue inflammation, local necrosis, calcinosis cutis. Musculoskeletal and connective tissue disorders: Tingling sensation. Nervous system disorders: Anxiety. Vascular disorders: Hypotension, flushing (rapid inj), syncope. Potentially Fatal: Circulatory collapse.
Monitor serum Ca concentrations (every 4-6 hours during intermittent infusions or every 1-4 hours during continuous infusion); albumin, serum phosphate, and Mg; ECG and vitals (as necessary).
Overdosage
Symptoms: Anorexia, nausea, vomiting, constipation, abdominal pain, polyuria, polydipsia, dehydration, muscle weakness, bone pain, mental disturbances, renal calcification, drowsiness, neurologic symptoms (e.g. confusion), hypertension; severe cases: cardiac arrhythmias, cardiac arrest, and coma. Management: Supportive treatment. In case of severe hypercalcaemia, administer 0.9% NaCl IV for plasma expansion, concomitantly with or followed by furosemide to increase Ca excretion. Administer calcitonin to lower serum Ca concentration. Monitor serum electrolytes (e.g. K, Mg), ECG. If patient remains acutely symptomatic, consider performing haemodialysis or peritoneal dialysis.
Drug Interactions
Increased risk of hypercalcaemia with thiazide diuretics and vitamin D or A. May enhance effects and toxicity of cardiac glycosides (e.g. digoxin). Enhanced β-adrenergic effects of epinephrine. May decrease the absorption and effects of Ca channel blockers (e.g. verapamil), bisphosphonates (e.g. alendronate), oral fluoroquinolones, and tetracyclines. Potentially Fatal: Concomitant use of IV Ca gluconate and ceftriaxone may result to precipitates in the lungs and kidneys, particularly in neonates (≤28 days of age).
Lab Interference
May produce false decrease in serum and urine Mg concentrations.
Action
Description: Mechanism of Action: Calcium regulates the function of the nervous and muscular systems by facilitating the action potential excitation threshold. It is also essential in maintaining the functional integrity of the cell-membrane and capillary permeability. Pharmacokinetics: Absorption: Primarily absorbed from the small intestine predominantly in the duodenum (minimal) via active transport and passive diffusion, dependent on calcitriol and vitamin D. Bioavailability: 100% (IV). Distribution: Ca crosses the placenta and enters breast milk. Mainly distributed in the skeleton (99%); within the extracellular fluids and soft tissues (1%). Plasma protein binding: Approx 40%, mainly to albumin. Excretion: Mainly via faeces (75% as unabsorbed Ca salts); urine (20%).
Chemical Structure
Calcium gluconate Source: National Center for Biotechnology Information. PubChem Database. Calcium gluconate, CID=9290, https://pubchem.ncbi.nlm.nih.gov/compound/9290 (accessed on June 25, 2020)
Storage
IV: Store between 20-25°C. Do not freeze. Oral: Refer to product guideline for specific requirements.
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