8/11/2014

NW Newborn Drug Protocol - Calcium Gluconate Administration

Newborn Services Drug Protocol

Note: The electronic version of this guideline is the version currently in use.
Any printed version can not be assumed to be current. Printed copies of this document are valid for Saturday, November 08, 2014.
The general disclaimer regarding use of Newborn Services Guidelines and Protocols applies to this guideline.

CALCIUM GLUCONATE
Calcium gluconate

Reviewed by Brenda Hughes, Rob Ticehurst, and Dr Carl Kuschel

June 2003

Management of Calcium Administration

Description
IV preparation
Clear colourless solution containing 10% solution (calcium gluconate 100mg/ml, equivalent to
elemental calcium 8.9mg/ml or 0.22mmol/ml)
pH 7-8.
Oral preparation
Currently Pharmacy will supply Calcium Sandoz 1000 tablest to be used for preparation of an
elemental calcium solution of 1mmol/ml. For each dose:
Crush one Calcium Sandoz 1000 tablet in the foil wrapper.
Dissolve this in 15ml of sterile water and wait for the bubbles to stop.
Make volume up to 25ml with sterile water. Mix well.
This makes a Calcium oral solution of 1mmol elemental calcium per ml
Make a fresh solution for each dose and discard the remainder.
Prescription
Calcium slow infusion: Charted on stat page of prescription chart stating mmol/dose (and ml of
10% solution) and volume of compatible fluid.
Calcium infusion via a volumetric infusion pump: Charted on fluid chart only stating 10%
calcium gluconate and volume to be added.
Calcium orally: Charted on prescription chart as mmol of elemental calcium.

Administration
Slow IV Infusion
1. Administered by a nurse with Neonatal IV Drug Certification. Calcium is added to IV fluids as
per GL/NWH IV policy.
2. Compatible with sodium chloride 0.9%, glucose 5%, glucose 10%. Consult pharmacy for
further IV compatabilities.
3. Dilute 1 in 5 prior to administration (i.e. - to 0.045mmol/ml of elemental calcium)
4. Filter prior to administration through a Pall 0.2 micron filter.
5. Administer IV by slow infusion over 5-10 minutes via a syringe pump at a rate of
0.22mmol/kg/hour (maximum of 0.0225 mmol/min)
6. Flush with sodium chloride 0.9% before and after administration.
7. Do NOT give by intra-arterial, intramuscular or subcutaneous injection.
8. Do NOT administer with IVN, blood, or blood products.
http://www.adhb.govt.nz/newborn/DrugProtocols/CalciumGluconateAdministration.htm

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8/11/2014

NW Newborn Drug Protocol - Calcium Gluconate Administration

Oral
1. Administer by diluting into the feed. Calcium absorption is increased with food. Both
absorption and urinary excretion of calcium are increased with high protein diets. 8
2. Do NOT administer phosphate at the same feed time.

Nursing Considerations
1.
2.
3.
4.
5.

Observe site closely for extravasation. Infiltration of tissues may cause local tissue necrosis.
Monitor for adverse reactions.
Continuous cardiac monitoring during administration of slow IV infusion via a syringe pump.
Observe for bradycardia and arrhythmia.
Assess gastro-intestinal status carefully during oral administration.

Storage
IV Preparation
At room temperature.
Oral Preparation
Prepare a fresh solution each time.

References
1

Mimouni F, Tsang RC. Disorders of calcium and magnesium metabolism, in Fanaroff AA, Martin RJ (Eds): Neonatal-perinatal
Medicine, ed 4. St Louis, CV Mosby Co, 1987, pp1077-1093.

Roberts RJ. Drug therapy in infants: Pharmacologic principles and clinical experience. Philadelphia, WB Saunders Co, 1984,
p294.

Scott SM, Ladenson JH, Aguanna JJ, et al. Effect of calcium therapy in the sick premature infant with early neonatal
hypocalcaemia. J Pediatr 1984; 104:747.

Broner CW, Stidham GL, Westenkirchner DF, Watson DC. A prospective, randomised, double-blind comparison of calcium
chloride and calcium gluconate therapies for hypocalcaemia in critically ill children. J Pediatr 1990: 117:986-9.

Nursing 97 Drug Handbook Springhouse 1997, p838-841.

Medicines for Children. Royal College of Paediatrics and Child Health. London: RCPCH Publicatiosn Ltd, 1999.

Northern Neonatal Network Neonatal Formulary, 3rd Edition 2000, BMJ Books.

Micromedex Healthcare Series. Exp.31 Oct 2001.

Calcium gluconate infection BP datasheet. Mulgrave North: FH Faulding & Co Ltd, 2001.

10

McClintock AD et al (Eds). Notes on injectable drugs (4th Ed). Wellington: New Zealand Healthcare Pharmacists' Assoc (Inc),
1999.

11

Paediatric Formulary (5th Ed). Guy's, St Thomas' and Lewisham Hospitals.

12

Loe E, et al. Paediatric Pharmacopoeia, Royal Children's Hospital Melbourne and Leicester Royal Infirmary Children's Hospital.
WB Suanders Co, Ltd, London, 1998.

13

Young TE, Mangum B (eds). Neofax 2000. Acorn Publishing, Raleigh, 2000.

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