CALCIUM GLUCONATE

Calcium Gluconate Information

Calcium Gluconate Injection B.P. is a clear, colourless solution used primarily for the prevention and treatment of calcium deficiency.Calcium is essential for the maintenance of the functional integrity of the nervous, muscular, and skeletal systems, and cell-membrane and capillary permeability. Calcium Gluconate is an important activator in many enzymatic reactions and is essential to a number of physiologic processes including the transmission of nerve impulses; contraction of cardiac, smooth, and skeletal muscles; renal function; respiration; and blood coagulation. Calcium also plays a regulatory role in the release and storage of neurotransmitters and hormones, in the uptake and binding of amino acids, in cyanocobalamin (vitamin B12) absorption and in gastrin secretion.

Parenteral administration of calcium gluconate is required in acute hypocalcaemia and hypocalcaemic tetany. It may be administered intravenously as an adjunct in the treatment of severe hyperkalaemia and as an aid in the treatment of depression due to over dosage of magnesium sulphate (calcium is the antagonist of magnesium toxicity). Intravenous injections of calcium have been used in the treatment of acute renal, biliary and intestinal colic.

Calcium Gluconate Warnings

Solutions of calcium salts, particularly calcium chloride, are irritable, and care should be taken to prevent extravasation during intravenous injection. Calcium salts should be given cautiously to patients with impaired renal function, cardiac disease, or Sarcoidosis. When used in large doses, serum calcium concentrations and kidney function should be determined weekly or at the first sign of hypercalcaemia, which is characterized by symptoms such as anorexia, lassitude, muscular and joint pains, nausea and vomiting, thirst and polyuria. Frequent determinations of serum calcium concentrations should be performed. Hypercalcaemia is rarely produced by administrations of calcium alone, but may occur when large doses are given to patients with chronic renal failure. Since hypercalcaemia may be more dangerous than hypocalcaemia, overtreatment of hypocalcaemia should be avoided. ECG monitoring is required when calcium is administered by intravenous injection for treatment severe hyperkalaemia. Calcium gluconate is a supersaturated solution. Do not use if a precipitate is present. There is no information available on the use of calcium gluconate during pregnancy. Calcium crosses into the breast milk. Problems have not been documented with the administration of calcium to women who are breastfeeding. Nevertheless, the decision to treat breastfeeding mothers with calcium should weigh the potential benefits to the mother against the potential harm to the infant.

Drug Interactions : Cardiac Glycosides: The inotropic and toxic effects of cardiac glycosides and calcium are synergistic and arrhythmias may occur if these drugs are given together (particularly when calcium is given intravenously). Intravenous administration of calcium should be avoided in patients receiving cardiac glycosides. If considered necessary, calcium should be given slowly in small amounts. Tetracyclines: Calcium is known to complex with tetracycline antibiotics, thus rendering them inactive. The two drugs should therefore not be mixed prior to parenteral administration. High vitamin D intake should be avoided during calcium therapy unless especially indicated. Administration of calcium may reduce the response to verapamil and possibly other calcium channel blockers.

Calcium Gluconate Side Effects

Calcium salts are irritating to tissue when administered by intramuscular or subcutaneous injection and cause mild to severe local reactions including burning, necrosis and sloughing of tissue, cellulitis, and soft tissue calcification; venous irritation may occur with intravenous administration. When injected intravenously, calcium salts should be administered slowly through a small needle into a large vein to avoid too rapid an increase in serum calcium and extravasation of calcium solution into the surrounding tissue with resultant necrosis. Patients may complain of tingling sensations, a sense of oppression or heat waves, and a calcium or chalky taste following intravenous administration of calcium salts.

Calcium Gluconate Overdose

Hypercalcaemia may occur when large doses of calcium gluconate are given, especially when such doses are given to patients with chronic renal failure. Symptoms of hypercalcaemia include anorexia, nausea, vomiting, constipation, abdominal pain, muscle weakness, mental disturbances, polydipsia, polyuria, bone pain, nephrocalcinosis, renal calculi, and in severe cases, cardiac arrhythmias, coma and cardiac arrest. A serum calcium concentration exceeding 10.5 mg per 100 mL (2.6 mmol/L) is considered a hypercalcaemic condition.

Calcium Gluconate Usage Guidelines

Calcium gluconate is usually administered intravenously as a 10% solution, by slow direct intravenous injection, or by continuous or intermittent intravenous infusion. Various maximum rates of administration have been recommended for direct intravenous injection, including 2 mL/min, 1.5 to 3 mL/min, and 5 mL/min. By intermittent infusion, a maximum rate of 2 mL/min (0.9 mEq of calcium ions/min) is suggested. During I.V. administration of calcium, close monitoring of serum calcium levels is essential. Calcium gluconate has also been given by intramuscular or, (rarely, subcutaneous injection to adults. However, these routes are not recommended because of the possibility of tissue necrosis, sloughing, and abscess formation. Extravasation should also be avoided for this reason. Subcutaneous injection and intramuscular injection is contraindicated in children

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