Calcium Gluconate

Liverpool Hospital Emergency Department

A) Gel (2.5%)


  • Hydrofluoric acid skin exposure  


  • 2.5% topical calcium gluconate gel (50g)
  • Alternatively, can mix calcium gluconate solution 10% 10ml with 30ml (30g) of  water-soluble gel 

Dosage and Administration 

  • Apply liberally to the exposure site 

Pit Falls:

  • If there is severe local pain or large exposures – a regional IV calcium infusion or  intraarterial infusion (using Biers Block technique) can be consider (DW clinical toxicology)

B) Intravenous (10%)

    Indications in Toxicology: 

    • Calcium Channel blocker OD 
    • Ethylene glycol toxicity with hypocalcaemia* only give if clinical signs of  hypocalcaemia or level is severe
    • Hypocalcaemia with systemic fluorosis due to ingestion / skin exposure with  hydrofluoric acid exposure
    • Iatrogenic hypermagnesaemia
    • Hyperkalaemia  


    • Calcium gluconate 10ml 10% = 1g = 2.2mmol = 0.22mmol/ml

    Dosage and Administration 

    • Hypocalcaemia
    • Hyperkalaemia
    • Hypermagnesaemia – Give 10ml 10% (2.2mmol) IV  over 10 mins (may require repeat dosing)  

    Ca channel blocker toxicity  

    • ADULT: 30-60ml 10% Ca gluconate (3-6g) over 5-10 mins
    • Repeat every 20 minutes 
    • Start an infusion aiming for ionised calcium 1.5-2mmol/L
    • PAEDS: 0.6ml/kg to maximum of 30ml 10% ca gluconate 
    • For Hydrofluoric acid burns – may be intradermal/ intraarterial/ intravenous infusion  with Biers block/nebulised 

    Side Effects 

    • Hypercalcaemia
    • Tissue necrosis  

    Pit Falls 

    • Avoid extravasation 
    • In hyperkalaemia with digoxin toxicity – aim to use insulin/dextrose & NaHCO3 &  Salbutamol via nebuliser as first line treatment.
    • Give Calcium gluconate if severe  arrhythmias or severe ECG changes.
    • The stone heart theory risk is overstated.