Calcium Gluconate

Oral
Hypocalcaemia and calcium deficiency states
Adult: 10-50 mmol daily, adjusted according to patient's needs.
Intravenous
Severe acute hypocalcaemia
Adult: 2.25 mmol by slow IV inj over 10 minutes, followed by 58-77 ml of 10% calcium gluconate solution in 0.5-1L of 5% dextrose solution as continuous IV infusion.
Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution. 
Intravenous
Hypocalcaemic tetany
Adult: 2.25 mmol by slow IV inj over 10 minutes, followed by 58-77 ml of 10% calcium gluconate solution in 0.5-1L of 5% dextrose solution as continuous IV infusion.
Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution. 
Intravenous
Severe hyperkalaemia
Adult: 10 ml of 10% calcium gluconate solution over 2 minutes, repeated every 10 minutes if needed. 
Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution.
Intravenous
Antidote in severe hypermagnesaemia
Adult: 10 ml of 10% calcium gluconate solution over 2 minutes, repeated every 10 minutes if needed. 
Child: Neonate and 1 mth-18 yr: 0.5 ml/kg of 10% calcium gluconate solution as a single dose. Max: 20 ml of 10% calcium gluconate solution.

Treatment of HF (hydrofluoric acid) burns
Gel preparations of calcium gluconate are used to treat hydrofluoric acid burns.

Patients with calcium renal calculi or history of renal calculi. Conditions associated with hypercalcaemia and hypercalciuria.

Impaired renal function; cardiac disease; hypercalcaemia-associated diseases, e.g. sarcoidosis; other malignancies. Pregnancy.

GI irritation; soft-tissue calcification, skin sloughing or necrosis after IM/SC inj. Hypercalcaemia characterised by anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, nephrocalcinosis, renal calculi; chalky taste, hot flushes and peripheral vasodilation.

Rapid intravenous injections of calcium gluconate may cause hypercalcaemia, which can result in vasodilation, cardiac arrhythmias, decreased blood pressure, and bradycardia. Extravasation of calcium gluconate can lead to cellulitis. Intramuscular injections may lead to local necrosis and abscess formation.
It is also reported that this form of calcium increases renal plasma flow, diuresis, natriuresis, glomerular filtration rate and prostaglandin E2 and F1-alpha levels
Potentially Fatal: Cardiac arrhythmias and coma.

Co-admin of high calcium doses with thiazide diuretics may result in milk-alkali syndrome and hypercalcaemia. May potentiate digoxin toxicity. Decreases effects of calcium-channel blockers. Enhanced absorption with calcitriol (a vitamin D metabolite).

Calcium gluconate is used to prevent or treat negative calcium balance. It also helps facilitate nerve and muscle performance as well as normal cardiac function.Gel preparations of calcium gluconate are used to treat hydrofluoric acid burns.This is because calcium gluconate reacts with hydrofluoric acid to form insoluble, non-toxic calcium fluoride.
Absorption: Soluble calcium is predominantly absorbed from the small intestine by active transport and passive diffusion. Small intestines by active transport and passive diffusion. There is increased absorption in calcium deficiency and during childhood, pregnancy and lactation.
Distribution: Crosses the placenta and enters breast milk.
Excretion: Excreted mainly in the kidneys (as excess calcium), faeces (as unabsorbed calcium) with traces found in sweat, skin, hair and nails

C: Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant use of the drug in pregnant women despite potential risks.