Calcium Gluconate
Calcium gluconate is a calcium salt used principally for parenteral correction of clinically significant hypocalcemia. Its injectable formulation is widely used in small-animal emergencies, including hypocalcemic tetany and eclampsia, and in large-animal calcium replacement. It also has a separate emergency role in protecting the heart from severe hyperkalemia. Oral calcium gluconate can provide maintenance supplementation.
Group
Calcium supplement
Mechanism of Action
Calcium gluconate dissociates to release calcium ions, increasing extracellular ionized calcium and restoring calcium-dependent nerve, skeletal-muscle and cardiac function. This reduces the abnormal neuromuscular excitability responsible for hypocalcemic tremors, tetany and seizures. In hyperkalemia, calcium increases the separation between the resting membrane potential and excitation threshold, temporarily improving cardiac electrical stability. It provides membrane stabilization rather than potassium removal.
Dose Rates
Dogs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 4.65–14.88 mg/kg | IV | Elemental calcium basis; equivalent to 0.5–1.6 mL/kg of 10% calcium gluconate containing 9.3 mg elemental calcium/mL. Infuse slowly with ECG monitoring. | |
| Severe hypocalcemia with tetany or seizures | 5–15 mg/kg | IV | ELEMENTAL calcium, not gluconate mass; administer over 10–30 minutes, slowly. Approximate volume of 10% gluconate is 0.54–1.6 mL/kg. | |
| Alternative fixed calcium gluconate dose | Reference only | IV | 75–500 mg calcium gluconate intravenously slowly; the fixed-dose passage does not explicitly assign the salt/elemental basis. | |
| Acute hypocalcemia | 4.65–13.95 mg/kg | IV | ELEMENTAL calcium: equivalent to 0.5–1.5 mL/kg of 10% gluconate containing 9.3 mg/mL elemental calcium. Give over 10–30 minutes to effect; halt for bradycardia or arrhythmia. | |
| Calcium gluconate salt-dose alternative | 8.742–13.02 mg/kg | IV | ELEMENTAL calcium calculated from 94–140 mg/kg gluconate salt using the explicit 9.3 mg elemental per 100 mg injectable gluconate basis. Give slowly to effect. | |
| Hyperkalemic cardiotoxicity | 4.65–9.3 mg/kg | IV | ELEMENTAL calcium; 0.5–1 mL/kg of 10% gluconate over 10–20 minutes with ECG monitoring. Stabilizes myocardium temporarily; does not remove potassium. | |
| Post-crisis calcium infusion | Reference only | IV | A historical course gives 10–15 mL/kg of 10% gluconate over 24 hours after the acute crisis; other passages use 60–90 mg/kg/day ELEMENTAL calcium. These are separate alternatives; do not mix salt and elemental mass. | |
| Oral calcium gluconate maintenance | Reference only | PO | 500–750 mg/kg/day calcium gluconate SALT orally divided into three daily doses. Do not calculate from the elemental-calcium injectable strength. | |
| Historical non-IV calcium gluconate administration | Reference only | PO | Older regimens include intraperitoneal injection or diluted SC calcium. Severe injection-site mineralization and panniculitis have been reported; these are not interchangeable with IV products or livestock-specific SC formulations. |
Cats
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 4.65–14.88 mg/kg | IV | Elemental calcium basis; equivalent to 0.5–1.6 mL/kg of 10% calcium gluconate containing 9.3 mg elemental calcium/mL. Infuse slowly with ECG monitoring. | |
| Severe hypocalcemia with tetany or seizures | 5–15 mg/kg | IV | ELEMENTAL calcium, not gluconate mass; administer over 10–30 minutes, slowly. Approximate volume of 10% gluconate is 0.54–1.6 mL/kg. | |
| Alternative fixed calcium gluconate dose | Reference only | IV | 75–500 mg calcium gluconate intravenously slowly; the fixed-dose passage does not explicitly assign the salt/elemental basis. | |
| Acute hypocalcemia | 4.65–13.95 mg/kg | IV | ELEMENTAL calcium: equivalent to 0.5–1.5 mL/kg of 10% gluconate containing 9.3 mg/mL elemental calcium. Give over 10–30 minutes to effect; halt for bradycardia or arrhythmia. | |
| Calcium gluconate salt-dose alternative | 8.742–13.02 mg/kg | IV | ELEMENTAL calcium calculated from 94–140 mg/kg gluconate salt using the explicit 9.3 mg elemental per 100 mg injectable gluconate basis. Give slowly to effect. | |
| Hypoparathyroidism-associated acute hypocalcemia | 9.3–13.95 mg/kg | IV | ELEMENTAL calcium; 1–1.5 mL/kg of the 9.3 mg/mL elemental preparation over 10–20 minutes. Also described for phosphate-enema hypocalcemia or puerperal tetany. | |
| Post-crisis calcium infusion | 2.5–3.75 mg/kg/hour | IV | Continuous | ELEMENTAL calcium: division of 60–90 mg/kg/day by 24 hours. Monitor calcium once to twice daily and titrate. |
| Historical non-IV calcium gluconate administration | Reference only | PO | Older regimens include intraperitoneal injection or diluted SC calcium. Severe injection-site mineralization and panniculitis have been reported; these are not interchangeable with IV products or livestock-specific SC formulations. |
Cattle
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 13.95–23.25 mg/kg | IV | ELEMENTAL calcium equivalent to 150–250 mg/kg calcium gluconate salt at the explicit 9.3% injectable elemental basis. Administer slowly to clinical and cardiac response. |
Horses
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 13.95–23.25 mg/kg | IV | ELEMENTAL calcium equivalent to 150–250 mg/kg calcium gluconate salt at the explicit 9.3% injectable elemental basis. Administer slowly to clinical and cardiac response. |
Sheep
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 13.95–23.25 mg/kg | IV | ELEMENTAL calcium equivalent to 150–250 mg/kg calcium gluconate salt at the explicit 9.3% injectable elemental basis. Administer slowly to clinical and cardiac response. |
Pigs
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemia | 13.95–23.25 mg/kg | IV | ELEMENTAL calcium equivalent to 150–250 mg/kg calcium gluconate salt at the explicit 9.3% injectable elemental basis. Administer slowly to clinical and cardiac response. |
Birds
| Use / stage | Dose | Route | Schedule | Instructions |
|---|---|---|---|---|
| Hypocalcemic tetany | 4.65–9.3 mg/kg | IV | ELEMENTAL calcium equivalent to 50–100 mg/kg calcium gluconate salt. Slow IV administration; formulation-specific diluted IM use is separately described. | |
| Egg binding | Reference only | IM | The historical instruction gives 1% calcium gluconate 0.01–0.02 mL per gram IM with warmth; the high per-gram volume requires species- and formulation-specific reassessment before calculation. |
Indications
- Acute symptomatic hypocalcemia in dogs and cats, including puerperal eclampsia, hypoparathyroid crises and hypocalcemia associated with phosphate-containing enemas.
- Hypocalcemia and parturient paresis in cattle and other livestock, using a suitable veterinary calcium formulation.
- Temporary cardiac membrane stabilization in dogs and cats with severe hyperkalemia and associated electrocardiographic abnormalities.
- Adjunctive calcium replacement in calcium-channel-blocker poisoning to support myocardial contractility and vascular tone.
- Oral maintenance supplementation for persistent calcium deficiency or hypocalcemia in selected patients.
Contraindications
- Hypercalcemia.
- Use cautiously with calcium-containing urinary calculi or kidney disease.
- Hypercalcemia; use particular caution with cardiac disease, renal disease or concurrent digitalis glycosides.
Interactions
- Oral calcium can impair absorption of iron, tetracyclines and fluoroquinolones.
- Avoid mixing injectable calcium with bicarbonate, phosphate, sulfate or tartrate solutions.
- Digitalis glycosides increase sensitivity to calcium-associated arrhythmias.
Adverse effects
- Hypercalcemia
- Constipation with oral supplementation
- Arrhythmias with rapid intravenous calcium
Toxicity
Excess calcium can cause hypercalcemia, cardiac instability and tissue mineralization.
Preparations
| Preparation | Form | Strength | Route |
|---|---|---|---|
| Calcium gluconate 10% injection Strength encoded as ELEMENTAL calcium: 9.3 mg/mL, corresponding to the described 10% calcium gluconate solution. Not 100 mg/mL elemental calcium. | Injection | 9.3 mg / mL | IV |
| Calcium gluconate 325 mg tablet Salt mass; not matched to elemental-calcium injection regimens. | Tablet | 325 mg / tablet | PO |
| Calcium gluconate 500 mg tablet Salt mass; not matched to elemental-calcium injection regimens. | Tablet | 500 mg / tablet | PO |
| Calcium gluconate 650 mg tablet Salt mass; not matched to elemental-calcium injection regimens. | Tablet | 650 mg / tablet | PO |
| Calcium gluconate 975 mg tablet Salt mass; not matched to elemental-calcium injection regimens. | Tablet | 975 mg / tablet | PO |
| Calcium gluconate 1000 mg tablet Salt mass; not matched to elemental-calcium injection regimens. | Tablet | 1000 mg / tablet | PO |
Monitoring and Administration
Monitor ionized calcium and clinical response; phosphate monitoring is needed when used as a binder. Monitor heart rate and ECG during intravenous treatment.
Give intravenous calcium slowly. Avoid extravasation; injectable calcium can cause severe tissue injury. Route suitability is product-specific.
Use clear injectable solutions. Crystals may be dissolved by warming to 30–40°C; do not use an unresolved precipitate. The source inconsistently states 97 and 100 mg gluconate per mL; the explicit 9.3 mg/mL elemental strength is used here.
When indicated, monitor magnesium, phosphorus, potassium, renal function and urinary calcium as well as serum calcium. Do not infer compatibility of an admixture from compatibility with a different diluent or concentration.
The source’s 10–15 mg/kg/hour infusion bullet does not clearly assign the calcium basis and is not converted. Its 20 mL volume cap also cannot be represented as a formulation-independent total-mg cap.
Oral calcium for cats after crisis is described as 50–100 mg/kg/day ELEMENTAL calcium divided three to four times daily, with a vitamin D analogue and progressive reduction of IV calcium.