1 gram= 4.65
meq (93 mg) 10 ml. Maximum IV rate: 1.5 ml/min or approximately 1 gram/ 7 minutes
Too rapid injection may decrease blood pressure or cause cardiac syncope. Calcium administration:
(Onset: rapid Duration: 30min to 2 hours.
). Recommended only in cases of hyperkalemia, hypocalcemia, or calcium antagonist blockade.
Treatment of
hypocalcemia: Acute hypocalcemic tetany (unless induced by alkalosis): give
1 gram calcium gluconate IV over 5 - 15 minutes. After 1-2 hours may be
necessary to repeat dose or add 2-3 grams calcium gluconate to 250-500ml and infuse over 12-24hours.
----Alternatively----
Symptomatic patient: give 1 gram
calcium gluconate over 5 - 15 minutes q1-2hours. If Tetany returns after
6 hours (3 grams calcium gluconate given) start continuous infusion [5-10g of
calcium gluconate /1000 ml D5W infused at rate to prevent tetany-usually 30 to 100 ml/hr]. Make sure magnesium levels are corrected
first - patients with hypocalcemia and hypomagnesemia will not respond to
calcium replacement. Alternative
therapy: give 0.3 to 2 mg elemental calcium/kg/hour as a continuous
infusion.
Asymptomatic
patient: 1 gram calcium gluconate IV q6-12h with careful monitoring of Ca++ levels.
Monitoring: during intensive therapy, monitor calcium levels at
least twice daily.
Differentiation of hypoparathyroidism vs Vitamin D
deficiency: Hypoparathyroidism: Decreased serum Ca++/serum PO4
increased/Alk phos normal. Vitamin D
deficiency: decreased Ca++ & PO4/ Alk phos
increased.
Calcium channel blocker blockade:
give 0.01 to 0.04 ml/kg of 10% CaCl IV over 5-10min; may
repeat q10minutes. May also use calcium gluconate 0.5-0.8g IV q10min. Some recommend 1gram CaCL over
5 minutes, q10-20min x 3 to 4 doses. Some degree of hypercalcemia may be
necessary. Calcium therapy is more effective in overcoming mild toxicity vs massive overdose since calcium channel blockade is noncompetitive.
PSVT Conversion:
1 gram of 10% CaCl over 2-3 minutes has been used to prevent hypotension associated with verapamil in PSVT conversion.
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