Look inside the book: Nursing 2025-2026 Drug Handbook

calcium acetate 213

calcium gluconate IV based on age and serum calcium level. ➤ Adjunctive treatment of magnesium intoxication Adults: Initially, 7 mEq IV. Base subsequent doses on patient’s response. ➤ During exchange transfusions Adults: 1.35 mEq IV with each 100 mL citrated blood. Neonates: 0.45 mEq IV after each 100 mL citrated blood. ➤ Hyperphosphatemia Adults: Initially, 2 capsules or tablets or 10 mL oral solution PO t.i.d. with meals. Titrate dose every 2 to 3 weeks until an acceptable serum phosphorus level is reached; watch for hyper calcemia. Most patients on dialysis need 3 to 4 capsules or tablets or 15 to 20 mL oral solu tion with each meal. ➤ Dietary supplement Adults: 500 mg to 2 g PO daily. ADMINISTRATION PO • Give drug with a full glass of water. • Give 1 to 1.5 hours after meals if GI upset occurs. IV Give calcium chloride and gluconate only by IV route. Dilute calcium gluconate before use in 5% dextrose or NSS per manufacturer’s in structions and assess for potential drug or IV fluid incompatibilities, especially with con current phosphate administration. Monitor ECG when giving calcium IV. Stop drug and notify prescriber if patient complains of discomfort. Alert: Extravasation may cause severe necrosis and tissue sloughing. Calcium glu conate is less irritating to veins and tissues than calcium chloride. Direct injection Don’t use scalp veins in children. Warm solution to body temperature before giving it. For calcium chloride, give at 0.5 to 1 mL/ minute (1.36 mEq/minute). For calcium gluconate bolus injection, don’t exceed an infusion rate of 200 mg/minute in adults or 100 mg/minute in children, including neonates. Give slowly through a small needle into a large vein or through an IV line containing a free-flowing, compatible solution.

After injection, keep patient recumbent for 15 minutes. Intermittent infusion Infuse diluted solution through an IV line containing a compatible solution. Incompatibilities: Calcium chloride: None listed by manufacturer. Consult drug compatibility reference for more informa tion. Calcium gluconate: Ceftriaxone, fluids containing bicarbonate or phosphate, lipid products, methylprednisolone, minocycline. ACTION Replaces calcium and maintains calcium level. Route Onset Peak Duration PO Unknown Unknown Unknown IV Immediate Immediate 30 min–2 hr Half-life: Unknown. ADVERSE REACTIONS CNS: anxiety; tingling sensations, sense of oppression or heat waves (IV use), syncope (rapid IV use). CV: bradycardia, arrhythmias, cardiac arrest (rapid IV use), decreased BP, vasodilation. GI: constipation, irritation, chalky taste, hemorrhage, nau sea, vomiting, thirst, abdominal pain. GU: polyuria, kidney stones. Metabolic: hyper calcemia. Skin: infusion-site reactions. INTERACTIONS Drug-drug. Bisphosphonates: May reduce absorption of bisphosphonate from GI tract. Give calcium salts at least 30 minutes after alendronate or risedronate, at least 60 minutes after ibandronate, and not within 2 hours of tiludronate or etidronate. Calcium channel blockers: Maydimin ish therapeutic effects of calcium channel blocker. Monitor therapy. Cardiac glycosides: May increase digoxin toxicity. Give calcium cautiously, if at all, to patients taking cardiac glycosides. Deferiprone: May decrease deferiprone serum level. Separate administration of de feriprone and oral calcium medications or supplements by at least 4 hours. Fluoroquinolones: Oral calcium may de crease absorption of oral quinolones. Con sider therapy modification. Give at least 2 hours before or 6 hours after Phoslyra. Iron supplements: May reduce iron absorp tion. Separate drug administration by 2 hours.

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