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1 High Alert Adverse Reactions/Side Effects

CNS: headche, tingling. CV: syncope, CARDIAC ARREST, arrhythmias, bradycardia. PDF Page #1
calcium gluconate (kal-see-um gloo-koh-nate) GI: constipation, nausea, vomiting. GU: calculi, hypercalciuria. Local: phlebitis.
Kalcinate Interactions
Classification Drug-Drug: Hypercalcemia increases the risk of digoxin toxicity. Chronic use
Therapeutic: mineral and electrolyte replacements/supplements with antacids in renal insufficiency may lead to milk-alkali syndrome. Ingestion by
Pregnancy Category C mouth decreases the absorption of orally administered tetracyclines, fluoroquin-
olones, phenytoin, and iron salts. Excessive amounts may decrease the effects of
Indications calcium channel blockers. Decreases absorption of etidronate and risedron-
PO, IV: Treatment and prevention of hypocalcemia. PO: Adjunct in the prevention of ate (do not take within 2 hr of calcium supplements). May decrease the effectiveness
postmenopausal osteoporosis. IV: Emergency treatment of hyperkalemia and hyper- of atenolol. Concurrent use with diuretics (thiazide) may result in hypercal-
magnesemia and adjunct in cardiac arrest or calcium channel blocking agent toxicity cemia. May decrease the ability of sodium polystyrene sulfonate to decrease se-
(calcium chloride, calcium gluconate). rum potassium.
Drug-Food: Cereals, spinach, or rhubarb may decrease the absorption of cal-
Action cium supplements. Calcium acetate should not be given concurrently with other cal-
Essential for nervous, muscular, and skeletal systems. Maintain cell membrane and cium supplements.
capillary permeability. Act as an activator in the transmission of nerve impulses and
contraction of cardiac, skeletal, and smooth muscle. Essential for bone formation Route/Dosage
and blood coagulation. Therapeutic Effects: Replacement of calcium in 1 gram of calcium gluconate contains 90 mg elemental calcium (4.5 mEq calcium).
deficiency states. Hypocalcemia (dosed as calcium gluconate)
Pharmacokinetics PO (Adults): 0.5 2 g daily in 2 4 divided doses.
Absorption: Absorption from the GI tract requires vitamin D. IV administration re- PO (Children and Infants): 500 725 mg/kg/day in 3 4 divided doses.
sults in complete bioavailability. PO (Neonates): 500 1500 mg/kg/day in 4 6 divided doses.
Distribution: Readily enters extracellular fluid. Crosses the placenta and enters IV (Adults): 2 15 g/day as a continuous infusion or in divided doses.
breast milk. IV (Children and Infants): 200 500 mg/kg/day as a continuous infusion or in 4
Metabolism and Excretion: Excreted mostly in the feces; 20% eliminated by the divided doses.
kidneys. IV (Neonates): 200 800 mg/kg/day as a continuous infusion or in 4 divided doses.
Half-life: Unknown. Cardiac arrest and calcium antagonist toxicity (dosed as calcium
TIME/ACTION PROFILE (effects on serum calcium) gluconate)
ROUTE ONSET PEAK DURATION IV (Adults): 500 800 mg (maximum 3 g/dose).
PO unknown unknown unknown IV (Children, Infants, and Neonates): 60 100 mg/kg/dose (maximum 3 g/
IV immediate immediate 0.52 hr dose).
Contraindications/Precautions Tetany (dosed as calcium gluconate)
Contraindicated in: Hypercalcemia; Renal calculi; Ventricular fibrillation. IV (Adults): 1 3 g may be administered until a response occurs.
Use Cautiously in: Patients receiving digitalis glycosides; Severe respiratory in- IV (Children, Infants, and Neonates): 100 200 mg/kg/dose over 5 10 min,
sufficiency; Renal disease; Cardiac disease. may repeat after 6 hr or continuous infusion up to 500 mg/kg/day.
Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.
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2 most hospital crash carts; physician should specify form of calcium desired. Doses
should be expressed in mEq.
NURSING IMPLICATIONS PO: Administer with a full glass of water, with or following meals. PDF Page #2

Assessment IM: IM administration of calcium gluconate can cause severe necrosis and tissue
Calcium Supplement/Replacement: Observe patient closely for symptoms of sloughing. Do not administer IM.
hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac ar- IV: IV solution should be warmed to body temperature and given through a small-
rhythmias, Chvosteks or Trousseaus sign). Notify physician or other health care bore needle in a large vein to minimize phlebitis. Do not administer through a
professional if these occur. Protect symptomatic patients by elevating and padding scalp vein. May cause cutaneous burning sensation, peripheral vasodilation, and
siderails and keeping bed in low position. drop in BP. Patient should remain recumbent for 30 60 min after IV administra-
Monitor BP, pulse, and ECG frequently throughout parenteral therapy. tion.
May cause vasodilation with resulting hypotension, bradycardia, ar- If infiltration occurs, discontinue IV. May be treated with application of heat, ele-
rhythmias, and cardiac arrest. Transient increases in BP may occur dur- vation, and local infiltration of normal saline, 1% procaine HCl, or hyaluronidase.
ing IV administration, especially in geriatric patients or in patients with High Alert: Administer slowly. High concentrations may cause cardiac arrest.
hypertension. Rapid administration may cause tingling, sensation of warmth, and a metallic
Assess IV site for patency. Extravasation may cause cellulitis, necrosis, and slough- taste. Halt infusion if these symptoms occur, and resume infusion at a slower rate
ing. when they subside.
Monitor patient on digitalis glycosides for signs of toxicity. Do not administer solutions that are not clear or that contain a precipitate.
Lab Test Considerations: Monitor serum calcium or ionized calcium, chlo- Direct IV: May be administered slowly undiluted by IV push. Rate: Administer at
ride, sodium, potassium, magnesium, albumin, and parathyroid hormone (PTH) a maximum rate of 50 100 mg calcium gluconate/min.
concentrations before and periodically during therapy for treatment of hypocal- Intermittent/Continuous Infusion: May be diluted to 50 mg/mL with D5W,
cemia. D10W, 0.9% NaCl, D5/0.25% NaCl,D5/0.45% NaCl, D5/0.9% NaCl, or D5/LR.
May cause decreased serum phosphate concentrations with excessive and pro- Rate: Maximum rate 120 240 mg/kg/hr (0.6 1.2 mEq/kg/hr).
longed use. When used to treat hyperphosphatemia in renal failure patients, moni- Syringe Incompatibility: metoclopramide, sodium or potassium phosphate.
tor phosphate levels. Y-Site Compatibility: aldesleukin, allopurinol, amifostine, amiodarone, az-
Toxicity and Overdose: Assess patient for nausea, vomiting, anorexia, thirst, treonam, bivalirudin, cefazolin, cefepime, ciprofloxacin, cisatracurium, cladri-
severe constipation, paralytic ileus, and bradycardia. Contact physician or other bine, dexmedetomidate, dobutamine, docetaxel, doxapram, doxorubicin lipo-
health care professional immediately if these signs of hypercalcemia occur. some, enalaprilat, epinephrine, etoposide, famotidine, fenoldopam, filgrastim,
gemcitabine, granisetron, labetalol, linezolid, melphalan, midazolam, milrinone,
Potential Nursing Diagnoses piperacillin/tazobactam, potassium chloride, prochlorperazine edisylate, propo-
Imbalanced nutrition: less than body requirements (Indications) fol, remifentanil, sargramostim, tacrolimus, teniposide, thiotepa, tolazoline, vino-
Risk for injury , related to osteoporosis or electrolyte imbalance (Indications) relbine, vitamin B complex with C.
Y-Site Incompatibility: amphotericin B cholesteryl sulfate, fluconazole, indo-
Implementation methacin, sodium or potassium phosphate.
High Alert: Errors with IV calcium gluconate and chloride have occurred sec-
ondary to confusion over which salt is ordered. Clarify incomplete orders. Confu- Patient/Family Teaching
sion has occurred with milligram doses of calcium chloride and calcium gluco- Calcium Supplement: Encourage patients to maintain a diet adequate in vitamin
nate, which are not equal. Chloride and gluconate forms are routinely available on D.
2015 F.A. Davis Company CONTINUED
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PDF Page #3
CONTINUED
calcium gluconate
Do not administer concurrently with foods containing large amounts of oxalic acid
(spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk or dairy
products). Administration with milk products may lead to milk-alkali syndrome
(nausea, vomiting, confusion, headache). Do not take within 1 2 hr of other
medications if possible.
Instruct patients on a regular schedule to take missed doses as soon as possible,
then go back to regular schedule.
Advise patient to avoid excessive use of tobacco or beverages containing alcohol
or caffeine.
Osteoporosis: Advise patients that exercise has been found to arrest and reverse
bone loss. Patient should discuss any exercise limitations with health care profes-
sional before beginning program.
Evaluation/Desired Outcomes
Increase in serum calcium levels.
Decrease in the signs and symptoms of hypocalcemia.
Why was this drug prescribed for your patient?

Canadian drug name. Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough Discontinued.