Description

• Clear colourless solution containing 10% solution (calcium gluconate 100mg/ml, equivalent to elemental calcium 8.9mg/ml or 0.22mmol/ml)
• pH 7-8.

• 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.

• 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.

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

Storage

IV Preparation

• At room temperature.

Oral Preparation

• Prepare a fresh solution each time.

References