Yes

Calcium Salt; Electrolyte Supplement, Oral; Electrolyte Supplement, Parenteral

Treatment and prevention of hypocalcemia; treatment of tetany, cardiac disturbances of hyperkalemia, cardiac resuscitation when epinephrine fails to improve myocardial contractions, hypocalcemia, or calcium channel blocker toxicity; calcium supplementation

C

In ventricular fibrillation during cardiac resuscitation; patients with risk of digitalis toxicity, renal or cardiac disease, hypercalcemia, renal calculi, hypophosphatemia

Avoid too rapid I.V. administration (1.5-3.3 mL/minute); use with caution in digitalized patients, severe hyperphosphatemia, respiratory failure or acidosis; avoid extravasation; may produce cardiac arrest; hypercalcemia may occur in patients with renal failure and frequent determination of serum calcium is necessary; the serum calcium level should be monitored twice weekly during the early dose adjustment period

<1%: Vasodilation, hypotension, bradycardia, cardiac arrhythmias, ventricular fibrillation, syncope, lethargy, mania, coma, erythema, decrease serum magnesium, hypercalcemia, elevated serum amylase, constipation, nausea, vomiting, abdominal pain, tissue necrosis, muscle weakness, hypercalciuria

Acute single oral ingestions of calcium salts may produce mild gastrointestinal distress, but hypercalcemia or other toxic manifestations are extremely unlikely. Symptoms of hypercalcemia include lethargy, nausea, vomiting, and coma.

Treatment is supportive. Severe hypercalcemia following parenteral overdose requires I.V. hydration. Urine output should be monitored and maintained at >3 mL/kg/hour. I.V. saline and natriuretic agents (eg, furosemide) can quickly and significantly increase excretion of calcium into urine.

Decreased effect:

Calcium may decrease the bioavailability of tetracyclines, fluoroquinolones, iron salts and salicylates, atenolol, and sodium polystyrene sulfonate

I.V. calcium may antagonize the effects of verapamil; large intakes of dietary fiber may decrease calcium absorption due to a decreased GI transit time and the formation of fiber-calcium complexes

Increased effect: I.V. calcium may increase the effects of quinidine and digitalis

Do not refrigerate solutions; IVPB solutions/I.V. infusion solutions are stable for 24 hours at room temperature

Standard diluent: 1 g/100 mL D₅W or NS; 2 g/100 mL D₅W or NS

Maximum concentration in parenteral nutrition solutions is 15 mEq/L of calcium and 30 mmol/L of phosphate

Incompatible with sodium bicarbonate, carbonates, phosphates, sulfates, and tartrates

When used to prevent or treat negative calcium balance (eg, osteoporosis), the calcium in calcium salts moderates nerve and muscle performance and allows normal cardiac function

Absorption: From the GI tract requires vitamin D; minimal absorption unless chronic, high doses are given; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment

Distribution: Crosses the placenta; appears in breast milk

Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the kidneys

Dosage is in terms of elemental calcium

0-6 months: 210 mg/day

7-12 months: 270 mg/day

1-3 years: 500 mg/day

4-8 years: 800 mg/day

Adults, male/female:

9-18 years: 1300 mg/day

19-50 years: 1000 mg/day

>51 years: 1200 mg/day

Female: Pregnancy:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Female: Lactating:

less than or equal to 18 years: 1300 mg/day

>19 years: 1000 mg/day

Dosage expressed in terms of calcium gluconate

Hypocalcemia: I.V.:

Neonates: 200-800 mg/kg/day as a continuous infusion or in 4 divided doses

Infants and Children: 200-500 mg/kg/day as a continuous infusion or in 4 divided doses

Adults: 2-15 g/24 hours as a continuous infusion or in divided doses

Hypocalcemia: Oral:

Children: 200-500 mg/kg/day divided every 6 hours

Adults: 500 mg to 2 g 2-4 times/day

Osteoporosis/bone loss: Oral: 1000-1500 mg in divided doses/day

Hypocalcemia secondary to citrated blood infusion: I.V.: Give 0.45 mEq elemental calcium for each 100 mL citrated blood infused

Hypocalcemic tetany: I.V.:

Neonates: 100-200 mg/kg/dose, may follow with 500 mg/kg/day in 3-4 divided doses or as an infusion

Infants and Children: 100-200 mg/kg/dose (0.5-0.7 mEq/kg/dose) over 5-10 minutes; may repeat every 6-8 hours or follow with an infusion of 500 mg/kg/day

Adults: 1-3 g (4.5-16 mEq) may be administered until therapeutic response occurs

Calcium antagonist toxicity, magnesium intoxication or cardiac arrest in the presence of hyperkalemia or hypocalcemia: Calcium chloride is recommended calcium salt: I.V.:

Infants and Children: 100 mg/kg/dose (maximum: 3 g/dose)

Adults: 500-800 mg; maximum: 3 g/dose

Maintenance electrolyte requirements for total parenteral nutrition: I.V.: Daily requirements: Adults: 8-16 mEq/1000 kcal/24 hours

Dosing adjustment in renal impairment: Cl_cr <25 mL/minute: Dosage adjustments may be necessary depending on the serum calcium levels

Do not administer orally with bran, foods high in oxalates, or whole grain cereals which may decrease calcium absorption

Rapid I.V. injection at a maximum rate of 50 mg/minute; for I.V. infusion, dilute to a maximum concentration of 50 mg/mL and infuse over 1 hour or no greater than 120-240 mg/kg/hour (0.6-1.2 mEq calcium/kg/hour)

Serum calcium: 8.4-10.2 mg/dL: Monitor plasma calcium levels if using calcium salts as electrolyte supplements for deficiency

Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended

In low albumin states, the corrected total serum calcium may be estimated by: Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum albumin)

calcium (S); magnesium

May cause drowsiness; may cause confusion and delirium (as a consequence of hypercalcemia)

None reported

No information available to require special precautions

No effects or complications reported

Do not take calcium supplements within 1-2 hours of taking other medicine by mouth or eating large amounts of fiber-rich foods; do not drink large amounts of alcohol or caffeine-containing beverages; take with food

Extravasation treatment (example):

Hyaluronidase: Add 1 mL NS to 150 unit vial to make 150 units/mL of concentration; mix 0.1 mL of above with 0.9 mL NS in 1 mL syringe to make final concentration = 15 units/mL

Do not infuse calcium gluconate solutions in the same I.V. line as phosphate-containing solutions (eg, TPN)

Elemental calcium listed in brackets

Tablet: 500 mg [45 mg], 650 mg [58.5 mg], 975 mg [87.75 mg], 1 g [90 mg]

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