Calcium gluconate

Calcium gluconate is the calcium salt of gluconic acid and is used as a mineral supplement and
medication.[1] As a medication it is used by injection into a vein to treat low blood calcium, high
blood potassium, and magnesium toxicity.[1][2] Supplementation is generally only required when
there is not enough calcium in the diet.[3] Supplementation may be done to treat or prevent
osteoporosis or rickets.[1] It can also be taken by mouth but is not recommended for injection into a
muscle.[1]

Side effects when injected include slow heart rate, pain at the site of injection, and low blood
pressure.[3] When taken by mouth side effects may include constipation and nausea.[1] Blood
calcium levels should be measured when used and extra care should be taken in those with a
history of kidney stones.[3] At normal doses, use is regarded as safe in pregnancy and
breastfeeding.[1][4] Calcium gluconate is made by mixing gluconic acid with calcium carbonate or
calcium hydroxide.[5]

Calcium gluconate came into medical use in the 1920s.[6] It is on the World Health Organization's
List of Essential Medicines.[7] Calcium gluconate is available as a generic medication.[2][8]

It is closely related to calcium borogluconate, which is commonly used in veterinary medicine

owning to its higher solubility. [9] It is used for intravenous administration of calcium, notably in
ruminants.[10]

Production

Calcium gluconate is produced commercially through three main methods. These three methods
are: chemical oxidation of glucose with a hypochlorite solution, electrolytic oxidation of a glucose
solution containing a known value of bromide, and a fermentation process where specific
microorganisms are grown in a medium containing glucose and various other ingredients.[11]

Medical uses

Low blood calcium

10% calcium gluconate solution (given intravenously) is the form of calcium most widely used in the
treatment of low blood calcium. This form of calcium is not as well absorbed as calcium lactate,[12]
and it only contains 0.93% (93 mg/dL) calcium ion (defined by 1 g weight solute in 100 mL of
solution to make 1% solution w/v). Therefore, if
Calcium gluconate
the hypocalcemia is acute and severe, calcium
chloride is given instead.

High blood potassium

Calcium gluconate is used as a cardioprotective

agent in people with high blood potassium levels,
with one alternative being the use of calcium
chloride.[13] It is recommended when the
potassium levels are high (>6.5 mmol/L) or when
the electrocardiogram (ECG) shows changes due
to high blood potassium.[2]

Though it does not have an effect on potassium Clinical data

levels in the blood, it reduces the excitability of Pronunciation KAL-see-um GLUE-koe-
cardiomyocytes, thereby lowering the likelihood
nate
of cardiac arrhythmias.[14]
AHFS/Drugs.com Monograph (https://
www.drugs.com/mon
Magnesium sulfate overdose ograph/calcium-salt
s.html)
It is also used to counteract an overdose of
License data US DailyMed: Calcium
Epsom salts magnesium sulfate,[15] which is
gluconate (https://dai
often administered to pregnant women in order to
lymed.nlm.nih.gov/da
prophylactically prevent seizures (as in a patient ilymed/search.cfm?la
experiencing preeclampsia). Magnesium sulfate beltype=all&query=Ca
is no longer given to pregnant women who are lcium+gluconate)
experiencing premature labor in order to slow or
Routes of By mouth,
stop their contractions (other tocolytics are now administration
intravenous, topical
used instead due to better efficacy and side
effect profiles). Excess magnesium sulfate ATC code A12AA03 (WHO (http

results in magnesium sulfate toxicity, which s://www.whocc.no/at

c_ddd_index/?code=
results in both respiratory depression and a loss
A12AA03) ) (Oral),
of deep tendon reflexes (hyporeflexia).
D11AX03 (WHO (http
s://www.whocc.no/at
c_ddd_index/?code=
 D11AX03) ),
Hydrofluoric acid burns
B05XA19 (WHO (http
s://www.whocc.no/at
c_ddd_index/?code=
B05XA19) )
(Parenteral)
A tube of calcium gluconate gel

Gel preparations of calcium gluconate are used to Identifiers

treat hydrofluoric acid burns.[16][17] The calcium IUPAC name [show]

gluconate reacts with hydrofluoric acid to form
CAS Number 299-28-5 (https://co
insoluble, non-toxic calcium fluoride. In addition
mmonchemistry.cas.
to a 2.5% calcium gluconate gel being applied
org/detail?cas_rn=29
directly to the chemical burn, the person may also
9-28-5)
receive calcium gluconate supplements because
the fluoride ion precipitates serum calcium, PubChem CID 9290 (https://pubche
causing hypocalcemia.[18] m.ncbi.nlm.nih.gov/c
ompound/9290)

DrugBank DB11126 (https://ww

Cardiac arrest w.drugbank.ca/drug
s/DB11126)
While intravenous calcium has been used in
cardiac arrest, its general use is not ChemSpider 8932 (https://www.ch
[1]
recommended. Cases of cardiac arrest in which emspider.com/Chemi
it is still recommended include high blood cal-Structure.8932.ht

potassium, low blood calcium such as may occur ml)

following blood transfusions, and calcium UNII SQE6VB453K (http

[1]
channel blocker overdose. There is the potential s://precision.fda.gov/
[1]
that general use could worsen outcomes. If uniisearch/srs/unii/S
calcium is used, calcium chloride is generally the QE6VB453K)
recommended form.[1] KEGG D00935 (https://ww
w.kegg.jp/entry/D009
Side effects 35)

ChEBI CHEBI:3309 (https://

Calcium gluconate side effects include nausea,
www.ebi.ac.uk/cheb
constipation, and upset stomach. Rapid
i/searchId.do?chebiId
intravenous injections of calcium gluconate may
=CHEBI:3309)
cause hypercalcemia, which can result in
vasodilation, cardiac arrhythmias, decreased
blood pressure, and bradycardia. Extravasation of ChEMBL ChEMBL2106119 (htt
calcium gluconate can lead to cellulitis. ps://www.ebi.ac.uk/c
Intramuscular injections may lead to local hembl/explore/comp
necrosis and abscess formation.[19] ound/ChEMBL21061
19)
It is also reported that this form of calcium
E number E578 (acidity
increases renal plasma flow, urine production,
regulators, ...)
sodium excretion,[20][21] glomerular filtration
rate,[22] and prostaglandin E2 and F1-alpha CompTox Dashboard DTXSID2029618 (htt
[23] (EPA)
levels. ps://comptox.epa.go
v/dashboard/chemic

Society and culture al/details/DTXSID202

9618)

Shortages of medical calcium gluconate were ECHA InfoCard 100.005.524 (https://

reported in November 2012 and November echa.europa.eu/subs
2015 in the United States.[13][24] tance-information/-/s
ubstanceinfo/100.00
Historically, intravenous calcium gluconate was
5.524)
used as an antidote for black widow spider
envenomation, often in conjunction with Chemical and physical data

muscle relaxants.[25] This therapy, however, has Formula C12H22CaO14

[26][27]
since been shown to be ineffective.
Molar mass 430.372 g·mol−1

3D model (JSmol) Interactive image (htt

ps://chemapps.stola
f.edu/jmol/jmol.php?
model=%5BCa%2B2%
5D.%5BO-%5DC%28%
3DO%29%5BC%40H%
5D%28O%29%5BC%4
0%40H%5D%28O%2
9%5BC%40H%5D%28
O%29%5BC%40H%5
D%28O%29CO.%5BO-
%5DC%28%3DO%2
9%5BC%40H%5D%28
O%29%5BC%40%40
H%5D%28O%29%5B
C%40H%5D%28O%2
 9%5BC%40H%5D%28
O%29CO)

Melting point 120 °C (248 °F)

(decomposes)

Solubility in water slowly soluble

SMILES [show]

InChI [show]

See also

Calcium lactate gluconate

Calcium citrate

Dicalcium phosphate

References

1. "Calcium Salts" (https://www.drugs.com/monograph/calcium-salts.html) . The American

Society of Health-System Pharmacists. Archived (https://web.archive.org/web/201701180413
41/https://www.drugs.com/monograph/calcium-salts.html) from the original on 18 January
2017. Retrieved 8 January 2017.

2. British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 680, 694.
ISBN 9780857111562.

3. World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary
2008. World Health Organization. p. 497. hdl:10665/44053 (https://hdl.handle.net/10665%2F44
053) . ISBN 9789241547659.

4. "Calcium gluconate Use During Pregnancy | Drugs.com" (https://www.drugs.com/pregnancy/c

alcium-gluconate.html) . www.drugs.com. Archived (https://web.archive.org/web/201701180
43743/https://www.drugs.com/pregnancy/calcium-gluconate.html) from the original on 18
January 2017. Retrieved 15 January 2017.
 5. Bhattacharya S (2014). Conventional and Advanced Food Processing Technologies (https://book
s.google.com/books?id=_JSlBAAAQBAJ&pg=PA391) . John Wiley & Sons. p. 391.
ISBN 9781118406304. Archived (https://web.archive.org/web/20170918185033/https://book
s.google.com/books?id=_JSlBAAAQBAJ&pg=PA391) from the original on 18 September
2017.

6. Tegethoff FW (2012). Calcium Carbonate: From the Cretaceous Period into the 21st Century (htt
ps://books.google.com/books?id=eSMGCAAAQBAJ&pg=PA308) . Birkhäuser. p. 308.
ISBN 9783034882453. Archived (https://web.archive.org/web/20170918185033/https://book
s.google.com/books?id=eSMGCAAAQBAJ&pg=PA308) from the original on 18 September
2017.

7. World Health Organization (2019). World Health Organization model list of essential medicines:
21st list 2019. Geneva: World Health Organization. hdl:10665/325771 (https://hdl.handle.net/1
0665%2F325771) . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.

8. "Competitive Generic Therapy Approvals" (https://www.fda.gov/drugs/generic-drugs/competiti

ve-generic-therapy-approvals) . U.S. Food and Drug Administration (FDA). 29 June 2023.
Archived (https://web.archive.org/web/20230629233651/https://www.fda.gov/drugs/generic-
drugs/competitive-generic-therapy-approvals) from the original on 29 June 2023. Retrieved
29 June 2023.

9. Macpherson HT, Stewart J (January 1938). "Investigations on the nature of calcium

borogluconate" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1263995) . Biochemical
Journal. 32 (1): 76–78. doi:10.1042/bj0320076 (https://doi.org/10.1042%2Fbj0320076) .
PMC 1263995 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1263995) . PMID 16746604
(https://pubmed.ncbi.nlm.nih.gov/16746604) .

10. Constable, P (November 2003). "Fluid and electrolyte therapy in ruminants". Veterinary Clinics
of North America: Food Animal Practice. 19 (3): 557–597. doi:10.1016/S0749-0720(03)00054-9
(https://doi.org/10.1016%2FS0749-0720%2803%2900054-9) . PMID 14608802 (https://pubm
ed.ncbi.nlm.nih.gov/14608802) .

11. Shindia AA, El-Sherbeny GA, El-Esawy AE, Sheriff YM (March 2006). "Production of gluconic
Acid by some local fungi" (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3769535) .
Mycobiology. 34 (1): 22–29. doi:10.4489/MYCO.2006.34.1.022 (https://doi.org/10.4489%2FMY
CO.2006.34.1.022) . PMC 3769535 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC376953
5) . PMID 24039465 (https://pubmed.ncbi.nlm.nih.gov/24039465) .
12. Spencer H, Scheck J, Lewin I, Samachson J (July 1966). "Comparative absorption of calcium
from calcium gluconate and calcium lactate in man". The Journal of Nutrition. 89 (3): 283–292.
doi:10.1093/jn/89.3.283 (https://doi.org/10.1093%2Fjn%2F89.3.283) . PMID 4288031 (http
s://pubmed.ncbi.nlm.nih.gov/4288031) .

13. Miller D, Faine B (December 2013). "The Calcium Quandary" (https://epmonthly.com/article/the

-calcium-quandary/) . Emergency Physicians Monthly. Archived (https://web.archive.org/web/
20151121123038/http://epmonthly.com/article/the-calcium-quandary/) from the original on
21 November 2015. Retrieved 20 November 2015.

14. Parham WA, Mehdirad AA, Biermann KM, Fredman CS (2006). "Hyperkalemia revisited" (https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC1413606) . Texas Heart Institute Journal. 33 (1): 40–
47. PMC 1413606 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1413606) .
PMID 16572868 (https://pubmed.ncbi.nlm.nih.gov/16572868) .

15. Omu AE, Al-Harmi J, Vedi HL, Mlechkova L, Sayed AF, Al-Ragum NS (2008). "Magnesium
sulphate therapy in women with pre-eclampsia and eclampsia in Kuwait". Medical Principles
and Practice. 17 (3): 227–232. doi:10.1159/000117797 (https://doi.org/10.1159%2F00011779
7) . PMID 18408392 (https://pubmed.ncbi.nlm.nih.gov/18408392) . S2CID 3079436 (https://
api.semanticscholar.org/CorpusID:3079436) .

16. el Saadi MS, Hall AH, Hall PK, Riggs BS, Augenstein WL, Rumack BH (June 1989). "Hydrofluoric
acid dermal exposure". Veterinary and Human Toxicology. 31 (3): 243–247. PMID 2741315 (http
s://pubmed.ncbi.nlm.nih.gov/2741315) .

17. Roblin I, Urban M, Flicoteau D, Martin C, Pradeau D (2006). "Topical treatment of experimental
hydrofluoric acid skin burns by 2.5% calcium gluconate". Journal of Burn Care & Research. 27
(6): 889–894. doi:10.1097/01.BCR.0000245767.54278.09 (https://doi.org/10.1097%2F01.BCR.
0000245767.54278.09) . PMID 17091088 (https://pubmed.ncbi.nlm.nih.gov/17091088) .
S2CID 3691306 (https://api.semanticscholar.org/CorpusID:3691306) .

18. Urden LD (2014). Critical Care Nursing : Diagnosis and Management (7th ed.). St. Louis, Mo.:
Elsevier/Mosby. p. 936. ISBN 978-0-323-09178-7. OCLC 830669119 (https://search.worldcat.or
g/oclc/830669119) .

19. Lam YM, Tse HF, Lau CP (April 2001). "Continuous calcium chloride infusion for massive
nifedipine overdose". Chest. 119 (4): 1280–1282. doi:10.1378/chest.119.4.1280 (https://doi.or
g/10.1378%2Fchest.119.4.1280) . PMID 11296202 (https://pubmed.ncbi.nlm.nih.gov/112962
02) .
20. Ruilope LM, Oliet A, Alcázar JM, Hernández E, Andrés A, Rodicio JL, et al. (December 1989).
"Characterization of the renal effects of an intravenous calcium gluconate infusion in
normotensive volunteers". Journal of Hypertension Supplement. 7 (6): S170 – S171.
doi:10.1097/00004872-198900076-00081 (https://doi.org/10.1097%2F00004872-198900076-
00081) . PMID 2632708 (https://pubmed.ncbi.nlm.nih.gov/2632708) .

21. Bernardi M, Di Marco C, Trevisani F, Fornalè L, Andreone P, Cursaro C, et al. (July 1993). "Renal
sodium retention during upright posture in preascitic cirrhosis". Gastroenterology. 105 (1):
188–193. doi:10.1016/0016-5085(93)90025-8 (https://doi.org/10.1016%2F0016-5085%2893%
2990025-8) . PMID 8514034 (https://pubmed.ncbi.nlm.nih.gov/8514034) .

22. Wong F, Massie D, Colman J, Dudley F (March 1993). "Glomerular hyperfiltration in patients
with well-compensated alcoholic cirrhosis". Gastroenterology. 104 (3): 884–889.
doi:10.1016/0016-5085(93)91026-e (https://doi.org/10.1016%2F0016-5085%2893%2991026-
e) . PMID 8440439 (https://pubmed.ncbi.nlm.nih.gov/8440439) .

23. Lahera V, Fiksen-Olsen MJ, Romero JC (February 1990). "Stimulation of renin release by
intrarenal calcium infusion" (https://doi.org/10.1161%2F01.hyp.15.2_suppl.i149) .
Hypertension. 15 (2 Suppl): I149 – I152. doi:10.1161/01.hyp.15.2_suppl.i149 (https://doi.org/1
0.1161%2F01.hyp.15.2_suppl.i149) . PMID 2404858 (https://pubmed.ncbi.nlm.nih.gov/24048
58) .

24. "FDA Drug Shortages" (http://www.accessdata.fda.gov/scripts/drugshortages/dsp_ActiveIngre

dientDetails.cfm?AI=Calcium+Gluconate+Injection&tab=tabs-4) . www.accessdata.fda.gov.
Archived (https://web.archive.org/web/20170918185034/https://www.accessdata.fda.gov/scr
ipts/drugshortages/dsp_ActiveIngredientDetails.cfm?AI=Calcium+Gluconate+Injection&source
=govdelivery&st=c&tab=tabs-4) from the original on 18 September 2017. Retrieved
21 November 2015.

25. Pestana C (July 2015). Dr. Pestana's Surgery Notes: Top 180 Vignettes for the Surgical Wards.
Simon and Schuster. ISBN 978-1-5062-0201-3.

26. Offerman SR, Daubert GP, Clark RF (2011). "The treatment of black widow spider envenomation
with antivenin latrodectus mactans: a case series" (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3200105) . The Permanente Journal. 15 (3): 76–81. doi:10.7812/tpp/10-136 (https://do
i.org/10.7812%2Ftpp%2F10-136) . PMC 3200105 (https://www.ncbi.nlm.nih.gov/pmc/article
s/PMC3200105) . PMID 22058673 (https://pubmed.ncbi.nlm.nih.gov/22058673) .
27. Clark RF, Wethern-Kestner S, Vance MV, Gerkin R (July 1992). "Clinical presentation and
treatment of black widow spider envenomation: a review of 163 cases". Annals of Emergency
Medicine. 21 (7): 782–787. doi:10.1016/S0196-0644(05)81021-2 (https://doi.org/10.1016%2FS
0196-0644%2805%2981021-2) . PMID 1351707 (https://pubmed.ncbi.nlm.nih.gov/135170
7) .

External links

"Calcium gluconate" (https://druginfo.nlm.nih.gov/drugportal/name/calcium%20gluconate) .

Drug Information Portal. U.S. National Library of Medicine.

Portal: Medicine