Calcium Gluconate

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

Dose: 

• 0.025 to 0.045 mmol Ca/kg/h (increase dose in refractory hypocalcemia)
• The following is a new, simplified method to prepare a calcium supplementation. Instead of preparing a separate infusion, Ca gluconate is added to the maintenance infusion. Generally only two concentrations are necessary: one for maintenance and the other for replacement. The resulting solution is run at the rate necessary to maintain the ordered TFI.

Solution Preparation:

• Add 5mL of 10% calcium gluconate to 95mL of IV solution = 0.012 mmol Ca or mL = 0.012 mmol Ca/mL*

*This concentration is the same as that currently supplied in most TPN solutions

• This solution replaces the maintenance solution and is run at the rate necessary to maintain the TFI at the desired amount
  • At 50 mL/kg/day the amount infused = 0.025 mmol Ca/kg/h
  • At 100 mL/kg/day the amount infused = 0.050 mmol Ca/kg/h
• The ordered TFI may be higher. Some of the TFI may be supplied by other infusions (E.G. arterial line, inotropes, antibiotics, etc.)
• In refractory cases hypocalcemia, or where the maintenance solution is running at a very low rate, the amount of calcium gluconate added to the solution may be higher. The absence of phosphate in the solution allows for higher concentrations of Ca without precipitation occurring
• Add 10mL of 10% calcium gluconate to 90mL of IV solution = 0.024 mmol Ca/mL or 24 mmol Ca/L

• IV push by a physician or CNS (may be given by a certified RN under a physician's supervision)
• Dilute 10% solution with equal parts of sterile water to make a 5% solution.
• 0.6 mL/kg of a 5% solution every 10 to 15 minutes

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