Electrolyte — Calcium Supplement Pregnancy: Limited data insufficient to inform drug-associated risk. There are risks to mother and fetus associated with hypocalcaemia in pregnancy.

Calcium Gluconate

Brand names: Calcium Gluconate 10%

Used in: Acute Kidney Injury Hyperkalaemia

Calcium gluconate is an intravenous calcium salt used to stabilise the myocardium in hyperkalaemia, to treat symptomatic hypocalcaemia, and as an antidote in magnesium toxicity, calcium-channel-blocker poisoning and hydrofluoric-acid exposure.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 1,000 mg to 2,000 mg (calcium gluconate) IV — adult (17 years and greater)

Route: Intravenous (bolus or continuous infusion via a secure IV line)

Frequency: Initial dose; subsequent doses of 1,000 mg to 2,000 mg every 6 hours if needed. Continuous infusion: initiate at 5.4 mg/kg/hour to 21.5 mg/kg/hour.

Max: For bolus administration, do not exceed an infusion rate of 200 mg/minute in adult patients

For treatment of acute, symptomatic hypocalcaemia. Individualise dose within the recommended range depending on severity of symptoms, serum calcium level, and acuity of onset. Do not dilute Calcium Gluconate in Sodium Chloride Injection prior to use. Measure serum calcium every 4-6 hours during intermittent infusions and every 1-4 hours during continuous infusion. Not physically compatible with fluids containing phosphate or bicarbonate. Note: the eMC bundle for this id was the Calvive oral calcium SPC (not the IV gluconate indication); posology taken from US labelling.

Paediatric dose

Dose: 29 mg/kg

Route: Intravenous

Frequency: Bolus 29 mg/kg to 60 mg/kg initial; subsequent 29 mg/kg to 60 mg/kg every 6 hours. Continuous infusion: initiate at 8 mg/kg/hour to 13 mg/kg/hour (paediatric, >1 month to <17 years).

Max: Bolus infusion rate not to exceed 100 mg/minute in paediatric patients

US labelling range is 29 mg/kg to 60 mg/kg per dose (dosePerKg records the lower bound of the stated range). Neonate (<1 month to 1 month): 100 mg/kg to 200 mg/kg initial, then 100 mg/kg to 200 mg/kg every 6 hours; continuous infusion 17 mg/kg/hour to 33 mg/kg/hour. Paediatric approval is not based on adequate and well-controlled clinical studies. Verify paediatric dosing against a children's formulary. Source: US labelling.

Dose adjustments

Renal

For patients with renal impairment, initiate at the lowest dose of the recommended dose ranges for all age groups and monitor serum calcium levels every 4 hours.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Paediatric weight-based calculator

Patient weight (kg)

Verify in a children's formulary

US labelling (FDA)

Reference — US labelling, may differ from UK

• Administer intravenously (bolus or continuous infusion) via a secure intravenous line (2.1) • See Full Prescribing Information (FPI) for administration rates, and appropriate monitoring (2.1) • Do not dilute Calcium Gluconate in Sodium Chloride Injection prior to use. Any unused portion should be discarded (2.1) • Individualize the dose within the recommended range in adults and pediatric patients depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia. See Table 1 in the FPI for dosing recommendations in mg of calcium gluconate for neonates, pediatric and adult patients. (2.2) • Measure serum calcium during intermittent …

Source: US FDA prescribing information (openFDA / DailyMed), label dated 2023-11-30. Accessed 2026-06-12. US dosing and indications can differ from UK practice — use UK sources for prescribing decisions.

Contraindications

Hypercalcaemia
Neonates (28 days of age or younger) receiving ceftriaxone

Side effects

Local soft tissue inflammation and necrosis, calcinosis cutis / calcification due to extravasation
Vasodilation
Decreased blood pressure
Bradycardia
Cardiac arrhythmia, syncope, cardiac arrest

Interactions

Cardiac glycosides (digoxin) — synergistic arrhythmias may occur; hypercalcaemia increases risk of digoxin toxicity; avoid, or give slowly in small amounts with close ECG monitoring
Calcium channel blockers — administration of calcium may reduce the response
Drugs that may cause hypercalcaemia (vitamin D, vitamin A, thiazide diuretics, oestrogen, calcipotriene, teriparatide) — monitor plasma calcium
Ceftriaxone — do not mix; risk of ceftriaxone-calcium precipitates (contraindicated in neonates 28 days or younger)

Clinical monograph

How it works

It raises extracellular calcium, restoring the membrane potential gradient and cardiac membrane stability; in hyperkalaemia it protects the heart from arrhythmia but does not lower the serum potassium.

Prescribing in practice

Extravasation causes severe tissue necrosis — give into a secure, free-flowing line (preferably a large vein) and stop immediately if extravasation is suspected.
It is incompatible with sodium bicarbonate and phosphate-containing solutions (calcium precipitation), so do not co-administer through the same line without flushing.
In hyperkalaemia it is cardioprotective only and must be combined with measures that actually lower potassium; use caution in patients taking digoxin, where calcium can worsen toxicity.

Monitoring

Monitor the ECG and cardiac rhythm during administration, check serum calcium (and the cause of any disturbance), and observe the infusion site closely for extravasation.

Counselling the patient

Warn the team that calcium in hyperkalaemia buys time by protecting the heart but does not reduce potassium, so definitive potassium-lowering treatment is still required.
Highlight the risk of tissue necrosis with extravasation and incompatibility with bicarbonate.
Flag particular caution in patients on digoxin.

Evidence & guidelines

Recommended for myocardial protection in hyperkalaemia and for symptomatic hypocalcaemia (Resuscitation Council UK; UK hyperkalaemia guidance).

Reference: TOXBASE (Calcium Channel Blocker OD); Resuscitation Council UK ALS 2021; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

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