Calcium Gluconate
Liverpool Hospital Emergency Department
A) Gel (2.5%)
Indications:
- Hydrofluoric acid skin exposure
Formulation:
- 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
Formulation:
- 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.