Electrolyte — Calcium Supplement
Pregnancy: Safe — used for maternal hypocalcaemia and neonatal resuscitation
Calcium Gluconate
Brand names: Calcium Gluconate 10%
Adult dose
Dose: Hypocalcaemia/hyperkalaemia: 10–20 mL of 10% IV over 2–10 min; Maintenance infusion: 10 mmol/hour
Route: IV
Frequency: As needed; repeat per clinical response
Max: Titrated to serum calcium and ECG response
10% calcium gluconate = 2.25 mmol/10 mL (0.225 mmol/mL). Used for: symptomatic hypocalcaemia, hyperkalaemia (cardioprotection — given first before insulin/dextrose/bicarbonate), calcium channel blocker overdose, hypermagnesaemia. Give slowly via large vein — bradycardia with rapid injection.
Paediatric dose
Dose: 0.5 mL/kg
Route: IV
Frequency: As needed
Max: 20 mL of 10%
Neonatal hypocalcaemia: 0.5–1 mL/kg of 10% IV over 5–10 min. Must be given slowly and separately from sodium bicarbonate. (of 10%)
Dose adjustments
Renal
Use with caution in hypercalcaemia — avoid unless symptomatic hypocalcaemia or hyperkalaemia.
Hepatic
No specific adjustment required.
Paediatric weight-based calculator
Neonatal hypocalcaemia: 0.5–1 mL/kg of 10% IV over 5–10 min. Must be given slowly and separately from sodium bicarbonate. (of 10%)
Clinical pearls
- In hyperkalaemia: calcium gluconate is the FIRST drug given — stabilises the myocardial membrane within 1–3 minutes (does NOT lower K+; buys time for definitive treatment)
- Calcium gluconate vs. calcium chloride: calcium chloride 10% contains 3× more elemental calcium per mL but is more caustic — use central line for chloride; gluconate safer peripherally
- Calcium channel blocker overdose antidote: high-dose calcium gluconate (10–20 mL 10% repeated) + high-dose insulin-euglycaemia therapy (HIE)
Contraindications
- Hypercalcaemia
- Digitalis toxicity (calcium potentiates digoxin toxicity — use with extreme caution)
- Ventricular fibrillation
Side effects
- Bradycardia (rapid injection)
- Hypercalcaemia (excess)
- Tissue necrosis on extravasation (10% solution — caustic)
- Flushing
- Nausea
Interactions
- Sodium bicarbonate (precipitates — NEVER mix in same line)
- Digoxin (potentiates toxicity — cardiac arrest risk)
- Tetracyclines (calcium binds and reduces absorption — oral)
Monitoring
- Serum ionised calcium
- ECG during administration (PR/QT changes)
- IV site (extravasation risk)
- Heart rate (bradycardia during injection)
Reference: BNFc; BNF 90; BNFc; TOXBASE (Calcium Channel Blocker OD); Resuscitation Council UK ALS 2021. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators