Calcium Gluconate DTP

Comprehensive vocabulary flashcards covering the pharmacology, clinical indications, contraindications, precautions, side effects, preparations, administration guidelines, and adult/paediatric dosing protocols for Calcium Gluconate according to Queensland Ambulance Service clinical guidelines.

Drug Class

Electrolyte

Pharmacology

Plays an integral role in muscular and neural systems; involved in skeletal muscle contraction, excitation coupling in cardiac and smooth muscle, and acts as an intracellular second messenger. These effects exert a positive inotropic effect post-cardiac arrest, stabilise the cardiac membrane in hyperkalaemia, and treat pain and systemic symptoms associated with hydrofluoric acid exposure.

Metabolism

Most parenterally administered calcium filtered by the renal glomeruli is reabsorbed; the remainder is excreted in urine.

Indications

1. Suspected hyperkalaemic cardiac arrest

2. Severe hyperkalaemia (with haemodynamic compromise and/or significant cardiac rhythm disturbance)

3. Verapamil and/or diltiazem toxicity

4. Hypotension associated with a magnesium infusion (that fails to respond to IV fluid therapy)

5. Hydrofluoric acid inhalation

6. Following pre-hospital blood product transfusion (adults: every unit; paediatrics: every 10ml/kg or unit).

Contraindications

1. Allergy and/or Adverse Drug Reaction

2. Digoxin (digitalis) overdose.

Precautions

Respiratory acidosis.

Side Effects

1. Syncope

2. Hypotension

3. Bradycardia

4. Cardiac dysrhythmias

5. Cardiac arrest.

Presentation

1. Vial of 2.2mmol in 10ml calcium gluconate monohydrate $10\%$

2. Injection pre-filled syringe with graduated markings of $4.4\,\text{mmol}/25\,\text{mL}$ calcium gluconate $8\%$.

Pharmacokinetics

Onset: 1-3 minutes

Duration: 30-60 minutes (in hyperkalaemia)

Half-life: not applicable.

Adult dosages

IV/IO: 4.4mmol, repeated at 10 minute intervals, total max dose 13.2mmol (60ml) (suspected hyperkalemic arrest)

IV/IO: 2.2mmol slow push over 2-3 minutes, repeated once at 10 minutes (severe hyperkalemia, hypotension post magnesium infusion).

IV/IO: 6.6mmol slow push of 2-3 minutes, repeated once at 10 minutes if required (verapamil and/or diltiazem toxicity).

NEB: 2ml of 2.5% concentration, repeated PRN, no max dose.

Mix 2.5ml of calcium gluconate 10% with 7.5ml in a 10ml syringe to achieve a concentration of calcium gluconate 2.5%.

IV/IO: 2.2mmol, slow push over 2-3 minutes, repeat until every unit is finished, max dose 6.6mmol (follow blood transfusion)

Paediatric dosages

IV/IO: 0.1mmol/kg (single dose not to exceed 2.2mmol), repeated once at 10 minutes if required (hyperkalemic cardiac arrest),

IV/IO: 0.1mmol/kg (single dose not to exceed 2.2mmol), slow push over 2-3 minutes, repeat once at 10 minutes if required. (Severe hyperkalemia, verapamil AND/OR diltiazem toxicity, hypotension post magnesium infusion)

IV/IO: 0.1mmol/kg (single dose not to exceed 2.2mmol), slow push over 2-3 minutes, repeat until every unit is transfused, max dose 6.6mmol (blood product transfusion)