Description and indication for use
Used in the treatment of hypocalcaemia
(Ionised Calcium < 1.1 mmol/L) in:
- Stable preterm infants only
when Ionised Calcium < 0.8 mmol/L
- Unstable preterm or term
infants with:
a. Cardiovascular instability (hypotension,
poor perfusion, metabolic acidosis, PPHN)
b. Encephalopathy
and/or seizures
c. Exchange
transfusion
Symptoms of hypocalcaemia in neonates may
include: muscle twitching, jitteriness, generalized seizures, and prolonged QT
interval.1
When treating hypocalcaemia, it should be
ensured that hypomagnesaemia is also treated if present. Correction of
hypomagnesaemia may also correct hypocalcaemia.
Dose
Symptomatic hypocalcaemia – acute treatment
IV Bolus:
0.11 mmol/kg
of Calcium Ions = 0.5 mL/kg of 10% Calcium Gluconate solution.
Hypocalcaemia – Acute treatment
IV Correction:
0.44 mmol/kg of Calcium Ions = 2.0 mL/kg of
10% Calcium Gluconate solution.
Hypocalcaemia – maintenance
IV Infusion:
1 mmol/kg/day of Calcium Ions = 4.5 mL/kg/day of 10% Calcium Gluconate solution.
Exchange transfusion:
Routinely, 0.22 – 0.44 mmol of Calcium Ions
(1-2 ml of 10% Calcium Gluconate solution) is given at every 100 mL point of the
exchange.
It may be injected slowly, or added to a
10mL aliquot. Calcium may be added before 100 mL of exchange if infant appears
symptomatic of hypocalcaemia.4
Reconstitution/Dilution
Available as: Calcium Gluconate 10%, 10 mL ampoules = 0.22 mmol Calcium Ions/mL.
IV Bolus and Correction:
Dilute 1 to 5: Add 1 mL of Calcium Gluconate
10% to 4 mL of Glucose 5% or 10% to give a final volume of 5 mL = 0.044 mmol
Calcium/mL.
IV Infusion:
Used for
maintenance.
Withdraw required dose and make up to
ordered volume of infusion solution (Glucose 5 or 10%).
Route and method of administration
Do not give by IM injection.3
Do not give intra-arterially.1
IV Bolus:
Give
diluted solution slowly over 20 to 60 minutes.
IV Correction:
Give
diluted solution over 6 hours using an infusion pump.
IV Infusion:
Continuous
IV infusion using an infusion pump.
Side effects
Rapid administration may cause bradycardia
or cardiac arrest.1
Cutaneous necrosis and/or calcium
deposition occurs with extravasation.1
Bolus doses via UAC have been associated
with intestinal bleeding and lower extremity tissue necrosis.1
Nursing responsibilities
Monitor
for bradycardia and arrhythmias on ECG whilst giving bolus doses
Observe IV infusion site closely for
extravasation.
Observe solution & complete length of
infusion line for precipitation (haziness).
Compatibility information3
Important: Contact pharmacy for
drugs not appearing in the table below. Uncommon drugs have simply been omitted
and may be incompatible
|
|
Compatible
|
Incompatible
|
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Fluids
|
Glucose
5%
Sodium chloride 0.9%
Glucose 10%.1
|
PN, IL
|
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Drugs
|
Amikacin, Aminophylline, Benzylpenicillin, Chloramphenicol, Frusemide, Heparin, Hydrocortisone, Magnesium Sulphate, Noradrenaline, Potassium Chloride, Tobramycin, Vancomycin, Verapamil.
|
Amphotericin, Clindamycin1, Dobutamine, Digoxin, Flucloxacillin, Fluconazole, Indomethacin1, Phosphate, Sodium Bicarbonate.
|
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Y-Site
|
Adrenaline, Ciprofloxacin, Dobutamine, Filgrastim, Heparin, Hydrocortisone, Meropenem, Potassium Chloride.
|
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References:
1.
Neofax
12th Ed. 1999 A Manual of Drugs Used in Neonatal Care, Young T,
Mangum O.
2.
Neonatal
Pharmacopoeia 1st Ed. 1998, Pharmacy Department, The Royal Women's
Hospital, Carlton 3053.
3.
Australian
Injectable Drugs Handbook, 2nd Ed., The Society of Hospital
Pharmacists of Australia, 1999.
4.
Royal
Women’s Hospital Continuum of Care – 9W-04-2-076 .