Calcium Gluconate Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Hypocalcemia

Intravenous:

500 to 2000 mg (5 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. The dose may be increased as needed. The usual daily dosage ranges from 1000 to 15,000 mg (10 to 150 mL) in divided doses or as a continuous infusion. Doses may be repeated every 1 to 3 days as needed and tolerated to normalize the serum calcium level.

Oral:

500 to 2000 mg orally 2 to 4 times a day.

Usual Adult Dose for Hypermagnesemia

1000 to 2000 mg (10 to 20 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose may be repeated as necessary in severe cases of hypermagnesemia (where discontinuation of exogenous magnesium is inadequate) to temporarily reverse many of the toxic effects of magnesium in the central nervous system.

Usual Adult Dose for Hyperkalemia

500 to 3000 mg (5 to 30 mL) IV one time at a rate not to exceed 0.5 to 2 mL/min. This dose may be repeated as necessary in cases of extreme hyperkalemia cardiotoxicity when P waves are absent, the QRS complexes are widened, and when continuous ECG monitoring is available. The use of calcium does not reduce the serum potassium level, but counteracts the effects of hyperkalemia on cardiac excitability.

Usual Adult Dose for Exchange Transfusion

300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min.

Usual Adult Dose for Osteoporosis

1000 to 1500 mg/day orally in divided doses.

Usual Pediatric Dose for Hypocalcemia

Neonatal:
Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium):
Oral: 400 mg/day
Daily maintenance calcium:
IV: 3 to 4 mEq/kg/day
Cardiac arrest in the presence of hyperkalemia or hypocalcemia, magnesium toxicity, or calcium antagonist toxicity: Dosage expressed in mg of calcium gluconate: IV or intraosseous IO:
60 to 100 mg/kg/dose; may repeat in 10 minutes if necessary. If effective, consider IV infusion.
Hypocalcemia (dose depends on clinical condition and serum calcium level):
IV: (Dose expressed in mg of calcium gluconate):
200 to 800 mg/kg/day as a continuous infusion or in 4 divided doses
Oral: (Dosage expressed in mg of elemental calcium):
50 to 150 mg/kg/day in 4 to 6 divided doses
Do not exceed 1 g/day
Dose expressed in mg of calcium gluconate:
500 to 1500 mg/kg/day in 4 to 6 divided doses
Hypocalcemia secondary to citrated blood infusion:
IV:
Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused
Tetany: (Dose expressed in mg of calcium gluconate):
IV: 100 to 200 mg/kg/dose over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day

Dosing: Usual
Adequate intake (AI): (Dosage is in terms of elemental calcium):
Oral:
1 to 6 months: 210 mg/day
7 to 12 months: 270 mg/day
1 to 3 years: 500 mg/day
4 to 8 years: 800 mg/day
9 to 18 years: 1300 mg/day

Recommended daily allowance (RDA): (Dosage is in terms of elemental calcium):
Oral:
1 to 6 months: 400 mg/day
6 to 12 months: 600 mg/day
1 to 10 years: 800 mg/day
11 to 24 years: 1200 mg/day

Hypocalcemia (dose depends on clinical condition and serum calcium level):
Oral: (Dose expressed in mg of elemental calcium):
Children: 45 to 65 mg/kg/day in 4 divided doses

Dose expressed in mg of calcium gluconate:
Infants and Children: 500 to 725 mg/kg/day in 3 to 4 divided doses

Hypocalcemia (dose depends on clinical condition and serum calcium level):
IV: (Dose expressed in mg of calcium gluconate):
Infants and Children: 200 to 500 mg/kg/day as a continuous infusion or in 4 divided doses

Cardiac arrest in the presence of hyperkalemia or hypocalcemia, magnesium toxicity, or calcium antagonist toxicity:
IV, IO: (Dosage expressed in mg of calcium gluconate):
Infants and Children: 60 to 100 mg/kg/dose (maximum: 3 g/dose); may repeat in 10 minutes if necessary; if effective, consider IV infusion.

Hypocalcemia secondary to citrated blood infusion:
IV: Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused

Tetany:
IV: (Dose expressed in mg of calcium gluconate):
Infants and Children: 100 to 200 mg/kg/dose; over 5 to 10 minutes; may repeat after 6 hours or follow with an infusion with a maximum dose of 500 mg/kg/day.

Daily maintenance calcium:
IV:
Infants and Children 25 kg and less: 1 to 2 mEq/kg/day
Children 25 to 45 kg: 0.5 to 1.5 mEq/kg/day
Children greater than 45 kg: 0.2 to 0.3 mEq/kg/day or 10 to 20 mEq/day

Renal Dose Adjustments

Patients with renal dysfunction have an increased risk of hypercalcemia. Periodically checking the serum calcium level, especially if signs or symptoms of hypercalcemia are detected, is recommended.

Liver Dose Adjustments

Data not available

Precautions

Calcium gluconate is contraindicated in patients with hypercalcemia, ventricular fibrillation, and in digitalized patients.

Calcium gluconate injection contains aluminum which may be toxic. Patients with impaired renal function, undergoing prolonged parenteral administration of calcium gluconate, should be monitored for clinical signs of aluminum toxicity. Clinicians should be aware these patients may achieve a level of aluminum accumulation capable of causing central nervous system and bone toxicity, as well as, tissue loading.

Dialysis

Calcium is removed by hemodialysis. To ensure a positive net calcium flux into the patient during dialysis, a dialysate calcium concentration of 3.0 to 3.5 mEq/L is usually required. Mid-dialysis hypercalcemia is not uncommon when this concentration is used.

Calcium is removed by peritoneal dialysis. The standard peritoneal dialysate contains 3.5 mEq/L of calcium (in 1.5% dextrose) to maintain a positive calcium balance and to prevent calcium losses. When higher concentrations of dextrose are used, the net calcium balance may be negative because of a greater convective removal of calcium during ultrafiltration, which counterbalances the diffusion of calcium from the dialysate to the patient.

Other Comments

The recommended daily allowance (RDA) of calcium for adults is 800 mg. The RDA for pregnant or lactating women is 1200 mg. Each 10 mL contains 1 g of calcium gluconate, or 90 mg elemental calcium, or 4.65 mEq of calcium.

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