Can cause tissue necrosis, so administer via central line or large patent IV access.If no bed available in ICU/HDU, can administer on a ward with telemetry monitoring Preferably- administer in HDU/ICU setting.This guideline is only used if severe symptoms and corrected Calcium 1.9mmol/L or less.Should be used only under the guidance of the Endocrinology Consult Service.High dose regimen (ref 6,7) - administer using an electronically controlled infusion device Post-parathyroidectomy- where corrected calcium is 1.9mmol/L or less. Doses similar to those used in hyperkalaemia (see above) have been used.May be repeated once if no ECG improvement with 1st doseĪs an antidote to magnesium in severe hypermagnesaemia (ref 5).Give 10 to 20ml of injection solution (2.25 to 4.5mmol calcium), preferably diluted in 50 to 100ml infusion fluid over 10 to 30 minutes. Hyperkalaemia with ECG changes or if K+ greater than 6mmol/L - myocardial protection (ref 3) Moderate to severe (without tetany or seizures): Give 40ml (9mmol calcium) in 500ml over four hours (smaller volume may be used in fluid restriction (ref 4)).Mild: Give 10 to 20ml (2.25 to 4.5mmol calcium) in 50 to 100ml infusion fluid over two hours.Hypocalcaemia (ref 8) (ref 3 for volume of administration) Measure serum calcium levels every four to six hours (ref 4,5).Initial rate 50ml/hour, adjusted according to response (ref 2) (use electronically controlled infusion device) This can be repeated as required or, if only temporary improvement, can be followed by an infusion of 22.5mmol (100ml injection solution) added to 900ml Sodium chloride 0.9% or Glucose 5%.Give 10 to 20ml of injection solution (2.25 to 4.5mmol calcium) with plasma calcium and ECG monitoring - each 10ml over five minutes (ref 1)(risk of arrythmias if given too rapidly).Severe acute hypocalcaemia/hypocalcaemic tetany (ref 2) If injection is administered too rapidly, nausea, vomiting, hot flushes, sweating, hypotension and vasomotor collapse, possibly fatal, may occur.There is a risk of arrythmias if the drug is given too quickly.Administer via a central line or large peripheral vein (ref 1).Administer very slowly (at least 5 minutes for 10ml) (ref 1).Slow intravenous injection (in emergency- eg severe acute hypocalcaemia, cardiac resus)(ref 1) If a 50ml infusion volume is used the residual volume in the infusion line must be flushed through at the same rate to avoid significant underdosing.Add required dose to a suitable volume of infusion fluid and administer as per 'Dose' overleaf.Intravenous infusion (administer using an electronically controlled infusion device) (preferred method) Sodium chloride 0.9% or Glucose 5% Methods of intravenous administration Calcium gluconate 10% (2.25mmol) per 10ml plastic ampoule (Braun) - unlicensed.AVOID rapid administration: may cause hot flushes, peripheral vasodilation, hypotension, nausea and vomiting, cardiac arrhythmias and arrest. May be given sequentially, provided the infusion lines are thoroughly flushed between infusions or different infusion sites are used (ref 5)
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