10% CALCIUM GLUCONATE Injection/Solution for

What is 10% CALCIUM GLUCONATE

10% Calcium Gluconate is a sterile, non-pyrogenic injectable solution used to treat or prevent calcium deficiencies. Each 10 ml plastic ampoule contains 1 gram of calcium gluconate, which is equivalent to approximately 93 mg of elemental calcium. Calcium is an essential mineral involved in numerous physiological processes including nerve function, muscle contraction, bone formation, and blood clotting.

• Therapeutic class: Electrolyte replenisher
• Formulation: Solution for injection, typically administered intravenously or slowly via deep intramuscular route under medical supervision
• Indications:
  • Acute symptomatic hypocalcemia
  • Calcium channel blocker overdose
  • Hyperkalemia-induced cardiac toxicity
  • Magnesium sulfate overdose
  • Adjunct treatment in resuscitation for cardiac arrest
• Presentation: 10ml plastic ampoule, typically supplied in packs of 50

This medication must be administered by healthcare professionals due to the risks associated with rapid intravenous administration and local tissue damage from extravasation. It is commonly used in emergency and critical care settings, making it a vital part of many hospital formularies.

How to use 10% CALCIUM GLUCONATE

Proper administration of 10% Calcium Gluconate is essential to maximize therapeutic benefit while minimizing the risk of adverse effects. The medication is typically administered intravenously (IV), although intramuscular (IM) use is sometimes considered in specific scenarios.

• Intravenous (IV) administration:
  • Preferred route in emergency settings
  • Administer slowly to avoid cardiac complications
  • Rate: Not more than 1.5 ml/min unless otherwise specified
• Intramuscular (IM) administration:
  • Only used when IV access is unavailable
  • Must be injected deeply into large muscles to reduce local irritation
• Dilution: May be diluted with 5% Dextrose or Normal Saline for infusion

Before administration, inspect the ampoule for particulate matter or discoloration. Use a new, sterile needle and syringe for each dose. Ensure venous access is patent and secure.

Important considerations:

• Monitor serum calcium levels regularly
• Use cardiac monitoring for patients receiving IV calcium in large doses
• Avoid extravasation; can lead to severe tissue necrosis
• Do not mix with phosphate or bicarbonate-containing solutions

Always consult a healthcare professional before use. Do not self-administer.

Mode of Action 10% CALCIUM GLUCONATE

Calcium Gluconate acts by increasing extracellular calcium levels, which in turn enhances neuromuscular transmission and muscle contractility. It is particularly vital in restoring proper calcium balance in the bloodstream and tissues during conditions such as hypocalcemia, hyperkalemia, and calcium channel blocker toxicity.

• Primary mechanism: Supplies bioavailable calcium ions (Ca²⁺) that regulate various physiological and biochemical processes
• Cardiac muscle: Increases myocardial contractility and helps stabilize cardiac membranes during arrhythmias or toxicity
• Neuromuscular system: Restores nerve conduction and muscle contraction, often impaired in low calcium states
• Cellular membrane stability: Counteracts hyperkalemia and hypermagnesemia by restoring electrical potential across cellular membranes

The calcium provided does not directly enter bone but corrects acute deficiencies and imbalances in extracellular fluid. It also reduces the excitability of neurons and muscle cells by regulating voltage-gated ion channels.

Unlike calcium chloride, calcium gluconate is less irritating to veins and is preferred when central access is not available. The onset of action is typically rapid with IV administration, and effects may last several hours depending on the underlying condition and calcium status.

10% CALCIUM GLUCONATE Interactions 10% CALCIUM GLUCONATE

Calcium Gluconate can interact with several drugs, affecting its efficacy or increasing the risk of side effects. Careful medication review is essential before administration, especially in critically ill or polymedicated patients.

• Calcium Channel Blockers (e.g., verapamil, diltiazem): Calcium gluconate may reduce their effects and is often used to reverse toxicity in overdose
• Digitalis (Digoxin): Concomitant use may lead to arrhythmias; IV calcium must be administered cautiously
• Tetracyclines and Quinolones: Oral calcium can bind to these antibiotics in the gut, reducing their absorption
• Bisphosphonates: Avoid simultaneous administration as calcium may interfere with their effectiveness
• Magnesium sulfate: Antagonistic relationship; calcium gluconate is used to reverse magnesium toxicity
• Thiazide diuretics: May increase the risk of hypercalcemia by reducing renal calcium excretion

Administration precautions:

• Do not co-administer with phosphates or carbonates due to risk of precipitation
• Check compatibility with IV fluids or additives
• Monitor ECG and serum electrolyte levels during therapy

Always inform your healthcare provider of all medications, supplements, or herbal products being used to avoid harmful interactions.

Dosage of 10% CALCIUM GLUCONATE

The dosage of 10% Calcium Gluconate must be tailored to the patient’s age, weight, clinical condition, and severity of calcium deficiency or indication. It should always be administered under medical supervision with appropriate monitoring.

• Adults:
  • Usual dose: 10 ml (1 g calcium gluconate) IV slowly over 5-10 minutes
  • May repeat every 1–2 days as needed, based on serum calcium levels
• Pediatrics:
  • Neonates: 100–200 mg/kg/dose IV over 5–10 minutes
  • Children: 60–100 mg/kg/dose IV every 6–8 hours as needed
• Calcium channel blocker overdose:
  • May require multiple boluses or continuous infusion
  • Monitoring of ionized calcium is essential

Administration tips:

• Use a central line if available for large or repeated doses
• Slow administration reduces the risk of arrhythmias
• Always monitor serum calcium, magnesium, potassium, and ECG

Dose adjustments may be necessary in renal impairment. Avoid exceeding recommended doses to prevent hypercalcemia and tissue damage.

Possible side effects of 10% CALCIUM GLUCONATE

Like all medications, 10% Calcium Gluconate may cause side effects, particularly when administered rapidly or in large amounts. Most adverse effects are related to cardiovascular, gastrointestinal, or local site reactions.

• Common side effects:
  • Flushing or feeling of warmth
  • Nausea or vomiting
  • Mild hypotension
• Serious side effects:
  • Cardiac arrhythmias (especially with digoxin)
  • Bradycardia
  • Extravasation-induced tissue necrosis
  • Hypercalcemia (fatigue, confusion, polyuria, constipation)
• Local reactions:
  • Pain, swelling, or burning at injection site
  • Thrombophlebitis

Severe complications are rare when the drug is used correctly and monitored appropriately. Immediate medical attention is needed for symptoms like chest pain, palpitations, or signs of tissue damage at the injection site.

10% CALCIUM GLUCONATE Contraindications 10% CALCIUM GLUCONATE

10% Calcium Gluconate should not be used in certain clinical situations where it may worsen the patient's condition. A full medical history and lab assessment should guide its use.

• Hypercalcemia: Contraindicated in patients with elevated blood calcium levels
• Ventricular fibrillation: May exacerbate arrhythmias
• Concomitant use with digoxin (IV): Increases risk of severe arrhythmias
• Severe renal impairment: Use cautiously due to risk of calcium accumulation
• Hypersensitivity: Avoid in patients with known allergy to calcium gluconate or excipients

In pregnancy and lactation, the drug should be used only if clearly needed and under medical supervision. Routine monitoring of serum calcium is essential to avoid toxicity, especially in vulnerable populations like neonates and elderly patients.

Storage of 10% CALCIUM GLUCONATE

Proper storage of 10% Calcium Gluconate is essential to maintain its sterility, potency, and stability. Inappropriate conditions can compromise its safety and effectiveness.

• Storage temperature: Store below 25°C (77°F); do not freeze
• Protect from light: Keep ampoules in original packaging until use
• Shelf life: Check the expiry date on the label; do not use after expiry
• Do not use if:
  • Solution appears cloudy or discolored
  • Particles are visible
  • Seal is broken or ampoule is cracked

Once opened, the ampoule must be used immediately. Unused portions should be discarded, as the solution contains no preservatives. Follow institutional guidelines for storage in emergency or crash carts where calcium gluconate is frequently stocked.