Calcium Gluconate 10%

How it works

Calcium ions antagonise the membrane effects of hyperkalaemia by restoring the resting potential and stabilise myocardial and neuromuscular excitability.

Prescribing in practice

• It provides less elemental calcium per volume than calcium chloride, so the salts are not interchangeable and the correct salt and strength must be confirmed for the indication.
• It is less irritant than calcium chloride and so is often preferred for peripheral administration, but extravasation can still cause tissue injury and it should be given slowly with cardiac monitoring.
• Avoid co-administration with bicarbonate- or phosphate-containing fluids, which precipitate, and use caution in patients taking digoxin.

Monitoring

Monitor ECG continuously alongside serum calcium and potassium, and watch the cannula site during administration.

Counselling the patient

• Keep calcium-containing and bicarbonate/phosphate infusions in separate lines.
• In hyperkalaemia calcium only buys time; potassium-lowering measures must follow.
• Distinguish clearly between calcium gluconate and calcium chloride preparations.

Evidence & guidelines

Calcium gluconate for cardioprotection in hyperkalaemia is recommended in UK renal association and Resuscitation Council UK hyperkalaemia guidance.