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Electrolyte

Calcium Gluconate 10%

Brand names: Calcium Gluconate 10% Injection

Adult dose

Dose: 10–30ml (2.25–6.75 mmol elemental calcium)
Route: IV over 5–10 min
Frequency: Repeat as clinically indicated; ECG-guided in hyperkalaemia
Max: 60ml per episode
Hyperkalaemia with ECG changes: 10–20ml IV over 5–10 min. Symptomatic hypocalcaemia: 10–20ml IV over 10 min. Tetany: 10ml IV over 5 min. Note: 10ml of 10% = 2.25 mmol elemental calcium.

Paediatric dose

Dose: 50 mg/kg
Route: IV slow over 5–10 min
Frequency: Single dose; repeat every 10 min if ECG changes persist
Max: 2000 mg
Concentration: 100 mg/ml
BNFc child 1 month–18 years: 0.5 mL/kg of 10% calcium gluconate IV over 5–10 min (max 20 mL = 2 g). Equivalent to 50 mg/kg of the 10% salt; provides ~4.5 mg/kg elemental calcium. Continuous ECG monitoring during administration; very irritant — use large vein, flush thoroughly. Ensure no concurrent ceftriaxone (calcium-ceftriaxone precipitate risk in neonates).
Paediatric weight-based calculator

BNFc child 1 month–18 years: 0.5 mL/kg of 10% calcium gluconate IV over 5–10 min (max 20 mL = 2 g). Equivalent to 50 mg/kg of the 10% salt; provides ~4.5 mg/kg elemental calcium. Continuous ECG monitoring during administration; very irritant — use large vein, flush thoroughly. Ensure no concurrent ceftriaxone (calcium-ceftriaxone precipitate risk in neonates).

Clinical pearls

  • In hyperkalaemia: calcium stabilises the cardiac membrane (reduces threshold potential) within 1–3 min. Does NOT lower serum potassium — follow with insulin/dextrose.
  • Calcium gluconate 10% is preferred over calcium chloride 10% for peripheral access — 3× less elemental calcium per 10ml but far less irritant if extravasated.
  • Calcium chloride 10% (6.8 mmol/10ml) = 3× more elemental calcium than gluconate (2.25 mmol/10ml) — use chloride via central line in life-threatening emergencies.
  • In digoxin toxicity: consider DigiFab (digoxin-specific antibody) instead of calcium — calcium risks precipitating asystole.

Contraindications

  • Hypercalcaemia
  • Digoxin toxicity (calcium potentiates toxic effects — risk of asystole)
  • Severe hypophosphataemia (metastatic calcification risk)

Side effects

  • Bradycardia and cardiac arrest with rapid IV injection
  • Peripheral vasodilation, flushing
  • Hypotension
  • Tissue necrosis and venous thrombosis if extravasated

Interactions

  • Sodium bicarbonate: precipitates — never in same IV line
  • Digoxin: potentiates toxicity (avoid if possible — use digoxin-specific antibody fragments instead)
  • Ceftriaxone: precipitates in neonates — do not co-administer via same line

Monitoring

  • Continuous ECG
  • serum calcium and potassium
  • BP during infusion

Reference: BNFc; UK Renal Association Hyperkalaemia Guidelines 2020; NICE BNF 84. Verify against your local formulary and the latest BNF before prescribing.

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