ASHP INJECTABLE DRUG INFORMATION Calcium Gluconate 239

Calcium Gluconate AHFS 40:12

Products continuous or intermittent intravenous infusion, the infusion rate should not exceed 200 mg of calcium gluconate per minute Calcium gluconate is available in 10- and 50-mL single-dose in adults or 100 mg of calcium gluconate per minute in pediatric (preservative-free) vials and 100-mL pharmacy bulk packages patients, including neonates.3289 as a 10% solution.3289 Each mL contains 100 mg of calcium gluconate (equivalent to 94 mg of calcium gluconate with 4.5 Intramuscular or subcutaneous injection of the drug is mg of calcium saccharate tetrahydrate) and hydrochloric acid not recommended because of possible severe necrosis and 183 184 185 359 3313 and/or sodium hydroxide for pH adjustment in water for injec- sloughing. If extravasation occurs or if clinical tion, providing 9.3 mg (0.465 mEq) of elemental calcium.3289 manifestations of calcinosis cutis are present, administration Aluminum also is present.3289 at that site should be discontinued and appropriate treatment should be instituted.3289 For direct intravenous injection, the calcium gluconate dose should be diluted in dextrose 5% or sodium chloride 0.9% to a concentration of 10 to 50 mg/mL.3289 For continuous intrave- Stability nous infusion, the calcium gluconate dose should be diluted in Calcium gluconate injection is a supersaturated solution that 3313 dextrose 5% or sodium chloride 0.9% to a concentration of 5.8 has been stabilized by the addition of calcium saccharate. 3289 to 10 mg/mL.3289 Intact vials should be stored at controlled room temperature. Freezing should be avoided.3289 The solution should appear clear pH and colorless to slightly yellow; the solution should not be used From 6 to 8.2.3289 if particulate matter or a precipitate is present or if discoloration 3289 Osmolarity has occurred. The manufacturer states that doses dispensed from the phar- The osmolarity is stated to be 680 mOsm/L.3313 macy bulk package and diluted solutions must be used imme- Osmolality diately.3289 Unused portions of single-dose vials should be The osmolality of a calcium gluconate 10% solution was deter- discarded immediately, and pharmacy bulk packages should be 3289 mined by osmometer to be 276 mOsm/kg.1233 discarded after 4 hours of initial puncture. Precipitation Administration Calcium gluconate injection is a supersaturated solution, and Calcium gluconate usually is administered intravenously, slowly such solutions are susceptible to precipitation.3289 If precipitates by direct intravenous injection, or by continuous or intermittent have formed, they may be dissolved by warming affected vials intravenous infusion, following appropriate dilution in dextrose to 60 to 80°C with occasional agitation until a clear solution 5% or sodium chloride 0.9%.3289 The drug diluted for infusion results, followed by vigorous shaking of the vials.3289 Warmed should be administered through a secure intravenous line.3289 vials should be allowed to cool to room temperature prior to When calcium gluconate diluted in a compatible infusion solu- dispensing.3289 Contents of such vials should only be used if they tion is administered slowly by direct intravenous injection or by are clear immediately prior to use.3289

Compatibility Information Solution Compatibility

Calcium gluconate

Test Soln Name Mfr Mfr Conc/L or % Remarks Ref C/I

Dextrose 5% in Ringer’s injection, BA PD 2 g Physically compatible for 24 hr 315 C lactated

Dextrose 5% in sodium chloride 0.9% 1 g Physically compatible 74 C

Dextrose 5% in sodium chloride 0.9% BA PD 2 g Physically compatible for 24 hr 315 C

Dextrose 5% 1 g Physically compatible 74 C

Dextrose 5% BA PD 2 g Physically compatible for 24 hr 315 C

DOI: 10.37573/9781585286850.066 240 Calcium Gluconate ASHP INJECTABLE DRUG INFORMATION

Solution Compatibility (Cont.)

Test Soln Name Mfr Mfr Conc/L or % Remarks Ref C/I

Dextrose 10% BA PD 2 g Physically compatible for 24 hr 315 C

Dextrose 10% BP 18 g Physically compatible for 30 hr at room 1347 C temperature under fluorescent light

Dextrose 20% BA PD 2 g Physically compatible for 24 hr 315 C

Ringer’s injection, lactated 1 g Physically compatible 74 C

Ringer’s injection, lactated BA PD 2 g Physically compatible for 24 hr 315 C

Sodium chloride 0.9% 1 g Physically compatible 74 C

Sodium chloride 0.9% BA PD 2 g Physically compatible for 24 hr 315 C

1 Sodium lactate ⁄6 M BA PD 2 g Physically compatible for 24 hr 315 C

Additive Compatibility

Calcium gluconate

Test Drug Mfr Conc/L or % Mfr Conc/L or % Test Solution Remarks Ref C/I

Amikacin sulfate BR 5 g UP 500 mg D5LR, D5R, Physically compatible and both stable 294 C D5S, D5W, for 24 hr at 25°C D10W, LR, NS, R, SL

Aminophylline 250 mg 1 g D5W Physically compatible 74 C

Amphotericin B 200 mg BP 4 g D5W Haze develops over 3 hr 26 I

Ascorbic acid UP 500 mg UP 1 g D5W Physically compatible 15 C

Ceftriaxone sodium Incompatible. Precipitate may form in 2222, 2731, I calcium-containing solutions 2784

Chloramphenicol PD 500 mg 1 g D5W Physically compatible 74 C sodium succinate

Chloramphenicol PD 10 g UP 1 g D5W Physically compatible 15 C sodium succinate

Chloramphenicol PD 10 g UP 1 g Physically compatible 6 C sodium succinate

Dobutamine HCl LI 182 mg VI 9 g NS Small particles form within 4 hr. White 552 I precipitate and haze after 15 hr

Dobutamine HCl LI 1 g ES 2 g D5W, NS Deeply pink in 24 hr at 25°C 789 I

Dobutamine HCl LI 1 g IX 50 g D5W, NS Small white particles in 24 hr at 21°C 812 I

Fat emulsion, intra- VT 10% PR 2 g Produced cracked emulsion 32 I venous

Fat emulsion, intra- KV 10% 7.2 and 9.6 Immediate flocculation, aggregation, 1018 I venous mEq and creaming

Floxacillin sodium BE 20 g ANT 2 g NS White precipitate forms immediately 1479 I

Furosemide HO 1 g ANT 2 g NS Physically compatible for 72 hr at 15 and 1479 C 30°C

Heparin sodium 12,000 units 1 g D5W Physically compatible 74 C

Heparin sodium UP 4000 units UP 1 g D5W Physically compatible 15 C