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Drug Details

Calcium Gluconate

• Drug Class Description
  Calcium supplements.
• Generic Name
  Generic
• Presentation
  Sterile Injection.
• Description
  9.5% of Calcium Gluconate in 10ml
• Indications
  Properties: Calcium is an essential body electrolyte. It is necessary for the functional integrity of nerve and muscle and is essential for the muscle contraction, cardiac function and coagulation of the blood. Calcium homeostasis is mainly regulated by three endocrine factors: parathyroid hormone is secreted in response to a fall in plasma calcium concentration and acts by accelerating calcium transfer from bone and by increasing its intestinal absorption and its renal reabsorption; calcitonin lowers plasma calcium by decreasing bone resorption and by increasing renal excretion of the ion; vitamin D stimulates intestinal absorption of calcium and decreases its renal excretion. Indications: Parenteral administration of calcium is indicated where the pharmacological action of a high calcium ion concentration is required, as for example, in acute hypocalcaemia, cardiac resuscitation and some cases of neonatal tetany. Intravenous injections of calcium have been used in the treatment of the acute colic of lead poisoning, and as an adjunct in the treatment of acute fluoride poisoning. Also, for the prevention of hypocalcaemia in exchange transfusions.
• Adult Dosage
  

  The normal concentration of calcium in plasma is within the range of 2.25 -2.75 mmol or 4.5-5.5mEq per litre. Treatment should be aimed at restoring or maintaining this level.

  During therapy, serum calcium levels should be monitored closely.

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

  Fluoride or lead poisoning: 0.3ml/kg (0.07mmol/kg)

  Neonatal tetany: 0.3ml/kg (0.07mmol/kg)

  Cardiac resuscitation: 7-15ml (1.54-3.3mmol). It should be noted that the absolute amount of calcium required for this indication is difficult to determine and may vary widely.

  In hypocalcaemic tetany, an initial intravenous injection of 10ml of the 10% solution (2.25mmol) should be followed by a continuous infusion of about 40ml (9mmol) daily. Plasma calcium should be monitored.

  Intravenous injections should be given very slowly (3 minutes for 10ml).

  Calcium Gluconate Injection can be diluted with glucose 5% or sodium chloride 0.9%. Dilution into a solution containing bicarbonate, phosphate or sulphate should be avoided.

  Elderly patients: Although there is no evidence that tolerance of Calcium Gluconate Injection is directly affected by advanced age, factors that may sometimes be associated with ageing, such as impaired renal function and poor diet, may indirectly affect tolerance and may require a reduction in dosage.

• Contra Indications
  

  Hypercalcaemia (e.g. in hyperparathyroidism, hypervitaminosis D, neoplastic disease with decalcification of bone), severe hypercalciuria, severe renal failure, patients receiving cardiac glycosides.

• Special Precautions
  

  Plasma calcium levels and calcium excretion should be monitored when calcium is administered parenterally, especially in children, in chronic renal failure or where there is evidence of calculi formation within the urinary tract. If plasma calcium exceeds 2.75mmol per litre or if 24 hour urinary calcium excretion exceeds 5mg/kg, treatment should be discontinued immediately as cardiac arrhythmias may occur at these levels.

  Calcium salts should be used with caution in patients with impaired renal function or with nephrocalcinosis. Care is also required in patients with cardiac disease.

  Calcium salts are irritant. The infusion site must be monitored regularly to ensure extravasation injury has not occurred.

  Calcium gluconate is physically incompatible with many other compounds. Care should be taken to avoid admixture of calcium gluconate and incompatible drugs in giving sets, or in the circulation after separate administration. Serious complications, including fatalities, have occurred following microcrystallisation of insoluble calcium salts in the body following separate administration of physically incompatible solutions or total parenteral nutrition solutions containing calcium and phosphate.

  The label shall state the following:

  WARNING: Check each ampoule for clarity of solution. Use only if clear

• Interactions
  

  The effects of digoxin and other cardiac glycosides may be accentuated by calcium and digitalis intoxication may be precipitated. There is increased risk of Hypercalcaemia with thiazides.

   

• Adverse Drug Reactions
  

  If Calcium Gluconate Injections is administered too rapidly, nausea, vomiting, hot flushes, sweating, hypotension and vasomotor collapse, possibly fatal, may occur. Soft tissue calcification due to extravasation of calcium solutions has been reported.