Calcium Gluconate 10%

OTHER ADULT INDICATIONS IN THE SAME SPC. Acute severe hyperkalaemia with or without ECG changes (serum potassium above 6.5 mmol/L): 30 mL of Calcium Gluconate 10% (6.69 mmol calcium) undiluted as a slow intravenous injection over 10 minutes; further doses can be considered after 5 minutes if needed until ECG improvement is achieved. Cardiac arrest due to hyperkalaemia: 30 mL of Calcium Gluconate 10% (6.69 mmol calcium) undiluted as a RAPID intravenous injection, repeatable if return of spontaneous circulation is not achieved within 5-10 minutes or if resuscitation is prolonged (onset of action within 3 minutes, duration 30-60 minutes). Normal plasma calcium is 2.25-2.75 mmol/L (4.5-5.5 mEq/L) in adults; treatment aims to restore or maintain this and serum calcium must be monitored closely. If plasma calcium exceeds 2.75 mmol/L, or 24-hour urinary calcium excretion exceeds 5 mg/kg, stop treatment immediately as cardiac arrhythmias may occur. SALT STRENGTH WARNING: 10 mL of calcium gluconate 10% contains 2.23 mmol calcium whereas 10 mL of calcium chloride 10% contains 6.8 mmol calcium — the difference must be accounted for to avoid medication errors. Must NOT be mixed with or given through the same line as sodium bicarbonate (risk of precipitation), or with phosphate-containing solutions. PAEDIATRIC dosing in this SPC is expressed in mL/kg of the 10% solution and mmol/kg (not mg/kg), so no structured per-kg mg dose is given here. Slow IV injection for urgent correction of acute symptomatic hypocalcaemia: neonates (0-27 days) a single dose of 1 mL/kg (0.22 mmol calcium/kg) undiluted over 5-10 minutes (lower doses of 0.5 mL/kg, 0.11 mmol/kg, have also been shown effective; may be diluted 1:1 or 1:5 in glucose 5%; rate not to exceed 0.22 mmol calcium/min); children 28 days to <18 years a single dose of 0.3-0.6 mL/kg (0.07-0.13 mmol calcium/kg) undiluted over 5-10 minutes (may be diluted 1:5; rate not to exceed 0.22 mmol calcium/min). Slow continuous infusion: neonates initially 0.2-0.3 mL/kg/hour (0.04-0.07 mmol calcium/kg) diluted 1:10 — an initial rate of 0.1 mL/kg/hour (0.02 mmol/kg/hour) has also been effective — with a maximum recommended rate in neonates of 0.1 mL/kg/hour (0.022 mmol/kg/hour); children 28 days to <18 years initially 0.08 mL/kg/hour (0.02 mmol calcium/kg/hour) diluted 1:10, maximum recommended rate 0.2 mL/kg/hour (0.045 mmol/kg/hour). A maximum dose of 1 mL/kg (0.22 mmol calcium/kg) is recommended in children 0 to <18 years because of the risk of aluminium exposure. For hyperkalaemia in children the cardiac arrest regimen should be followed: neonates 0.5 mL/kg (0.11 mmol calcium/kg) undiluted over 5-10 minutes given centrally where possible (if no central access, dilute five-fold with sodium chloride 0.9%), repeatable if ECG changes persist after 5-10 minutes; children 28 days to <18 years 0.5 mL/kg (0.11 mmol calcium/kg) — the remainder of this sentence is truncated in the fetched source. Verify all paediatric dosing against a children's formulary. NOTE: the US openFDA label fetched (Calcium Gluconate in Sodium Chloride Injection) uses different units and different figures (adults 1,000-2,000 mg initially, repeatable every 6 hours, continuous infusion 5.4-21.5 mg/kg/hour) — not used here; the UK SPC takes precedence.