Calcium Gluconate Drug Study

Calcium Gluconate  

Brand names

• Fresenius Kabi 
• Kalcinate  
• WG Critical Care 
• Topical Gel 

Pharmacological classification  

• Antidote 
• Supplement 
• Electrolyte 
• Mineral 

Therapeutic classification  

• Cardio protective agent 

Therapeutic Uses /Indications: 

It is a calcium salt primarily used for the treatment and prevention of  (Mnemonic: 2hypos 2hyper) 

• Hypocalcaemia 
• Hypercalcaemic tetany 
• Hyperparathyroidism  
• Hyperkalaemia (as a cardio-protective agent) 
• Hypomagnesaemia as an antidote 
• Exchange transfusions  

Route of Administration  

It can be administered  

• Orally 
• intravenously (IV) 
• intramuscularly (IM) (IM and SC routes are generally avoided  because of the risk of necrosis) 

Pharmacokinetics 

• When administered in IV form, dissociation of Calcium Gluconate into ionized calcium takes place in plasma, which makes it 100% bioavailable.  
• ABSORPTION: Oral form mainly into the small intestine (20-33% absorption rate). 
• Factors affecting absorption: 
• Vit-D metabolites 
• Luminal pH  
• Dietary elements like binding of the drug to phytates or fibre. 
• Elevated absorption during low calcium diets or un calcium deficiency  
• Distribution: 45% protein binding mainly to albumin, 8-10% to inorganic and organic acids. 
• Metabolism: Not metabolized extensively 
• Elimination: via faeces 80% as unabsorbed salt, 20% in urine 

Pharmacodynamics 

• The elemental calcium from calcium gluconate is very important for maintaining integrity of skeletal system, nervous system, cell membrane, muscular integrity and capillary permeability. 

• Cofactor in Enzymatic reactions 

• Essential for physiologic processes  

• Nerve impulse transmission  

• Muscle Contraction  

• Renal Function  

• Respiration  

• Blood Coagulation  

• Hormonal storage/release 

• Vitamin B12 absorption  

• Gastrin Secretion 

• The mechanism involves elevation of serum ionized calcium levels, maintenance of plasma calcium at 2.25-2.75 mmol/L.  

Calcium Gluconate Interactions/contraindications 

Calcium gluconate has number of  interactions 

• Cardiac Glycosides for example digoxin (Synergistic inotropic and toxic effects), IV calcium and Cardiac Glycosides are contraindicated. 
• Ceftriaxone: Form precipitates with calcium gluconate, contraindicated in neonates of age less than 28days. 
• Tetracyclines: Form complexes with Tetracycline, making them inactive so it is advised to avoid co-administration. 
• Calcium Channel blockers: e.g., verapamil reduce response is observed. 
• Drugs causing hypercalcemia: 
• Thiazide Diuretics 
• Vitamin-D Vitamin-A 
• Estrogen  
• Calcipotriene  
• Increase hypercalcemia risk 
• Monitor plasma calcium 

– Epinephrine as in post heart surgery patients it attenuates beta-adrenergic effect 

– Mutual antagonistic effect with Magnesium 

– Quinolones e.g., ciprofloxacin Reduces efficacy and absorption. 

Physical incompatibilities: Incompatible with  

• Amphotericin 
• Cephalothin 
• Cefazolin 
•  Ceftriaxone 
•  Dobutamine 
•  Prochlorperazine 
• and fluids containing 
•  oxidants,tartrates,bicarbonates citrates,sulfates or carbonates. 

 Storage 

• Store at 20-25°C or 68-77°F    (controlled room temperature). Protect from direct light and freezing. 
•  Available in the form of single-use vials 10 mL contains 1,000 mg or  in  bulk packages (100 mL containing 10,000 mg).  
• The container is not made with latex, sterile, non-PVC, non-DEHP and is sterile. 
• Discard any unused proportions 
•  Watch out if discoloured or presence of any particulate matter. 

Patient Information 

• Take as directed  
• Prefer taking it 1-2hrs after meal, in case of GI upset it could be taken with meal 
• Take divided doses 2-4 daily for hypocalcemia I.e., 500-2000miligram  
• IV dose can only be administered in hospital or under strict surveillance of physicians 
• Ask the patient to report any symptoms of motion sickness,  abdominal pain or irregular heart beat, as these symptoms are indicators of hypercalcemia. 
• For absorption of Calcium it is essential to maintain Vit-D levels in the body 
• Self dost adjustment is strictly prohibited. 
• Calcium levels monitoring via blood tests is essential  
• Take special care if lactating or pregnant  
• Keep away from direct or indirect reach of children 
• Watch out signs of allergic reactions or pain/swelling along with breathing difficulties. 

 Nursing Interventions (Detailed Focus) 

Calcium Gluconate needs focused Nursing Interventions for emphasizing safety because of higher risks of hypercalcemia,  extravasations and cardiac arrhythmias. Thus, it is essential to monitor assessment plan, administration,  patient education and collaboration with relevant department in case of any emergencies. 

Assessment: 

– Obtain Vital signs (baseline), including the heart rate,B.p, and respiratory rate. 

– Evaluate for any signs of hypercalcemia  

• Tetany 
•  Paraesthesia,  
• Muscle cramps 
• Chvostek’s/Trousseau’s signs) 
• hypercalcemia (e.g., lethargy, anorexia, polyuria). 

– Review lab values:  

• Serum calcium (total and ionized) 
• Adjustment of Protein Binding e.g., phosphorus, magnesium, potassium, albumin 
•  Renal function (e.g., BUN/creatinine to avoid use in severe impairment). 

– Evaluate ECG completely  for any significant changes for example 

• Prolonged QT ( in hypocalcemia) 
• Shortened QT (in hypercalcemia). 

– Check for any allergies 

– Current medications specially digoxin and ceftriaxone) 

– Any history of kidney stones or sarcoidosis  

– Assess Intravenous site for size  patency  

Administration: 

– For IV: Dilute in D5W or NS whichever is compatible; infuse slowly at the rate of 0.5-2 mL/min for adults and for neonates 0.5 mL/kg bolus. Never bolus the dose undiluted because risk of cardiac arrest elevated . For continuous infusion, use infusion pump for (e.g., 1-15 g per day divided or continuous dose for hypocalcaemia). 

– Avoid smaller veins (e.g., scalp, hand, foot) for prevention of extravasation; use of central line is recommended  if possible. 

– For oral: Post-meals administration is recommended  for better absorption. But if G.I upset occurs , it can be administered with meals 

– Avoid mixing with incompatible drugs; flush the line with Normal Saline before/after. 

– In case of any emergencies (e.g., hyperkalaemia): Administer 500-3,000 mg IV over the time span of 5-10 min with ECG monitoring. 

– Handle with greater care or ad   high-alert: Double-check the  dosage, rate of admin, and compatibility. 

Monitoring: 

– Special Care must be taken during IV administration and it is essential to watch out for any signs of hypotension, bradycardia,  ventricular fibrillation or AV block on ECG (continue till IV administration is complete) 

– Vital signs Monitoring must be carried out first at q15-30 min during infusion, and afterwards q4-6h. 

– Tracking serum calcium at q4-6h initially, afterwards daily; and monitoring of urinary calcium excretion in kidney patients is also of core importance. 

– Notice any signs of pain, redness or swelling at IV site, if any, stop infusion,  elevate the limb of the patient, aspirate, apply a cold compress, and immediately notify the provider (Surgical intervention or hyaluronidase may be needed) 

– Assess for any side effects: Locally watch out for burning/phlebitis and systematically for arrhythmias, hypotension,  flushing, and nausea. 

– In neonates: Monitoring for bradycardia and apnoea is very important; adjust doses relatively ( 0.11 mmol/kilogram bolus for hypocalcaemia). 

– For long-term use: Monitor the density of bone, renal calculi risk, and aluminium toxicity in impaired kidneys. 

Patient Education and Support: 

– Patients usually need continuous support, so it is essential to teach them signs of hypocalcaemia or hypercalcemia e.g., Fatigue and muscle twitching. 

– Instruct the patient on oral adherence, Meanwhile taking dietary calcium via greens/ dairy, as well as vitamin D, is important. 

– Patients taking Calcium Gluconate should avoid taking any supplements or antacids (OTC) without proper consultation  

– Chances of getting kidney stones are higher, so advise the patient to stay hydrated. 

Collaboration and Documentation: 

– It is recommended to collaborate with the relevant department pharmacist to rule out any contraindications,  specified patient conditions, and the provider’s orders 

– All assessments must be documented along with administrations and responses 

– Report ADRs to the relevant department without any delay 

– if overdosed: stop the infusion immediately, administer fluids and diuretics as it will help to excrete these via urine