First-lineCalcium gluconate 10%
Calcium Gluconate
Calcium salt
Antidote to magnesium toxicity; hyperkalaemia cardio-protection.
IV
First-line for
- Magnesium sulfate toxicity (respiratory depression)
- Hyperkalaemia cardio-protection
- Severe hypocalcaemia
Mechanism
Antagonises Mg²⁺ at NMJ; stabilises cardiac membrane.
MgSO4 toxicity
- Loss of reflexes → call team
- Resp depression → 1 g calcium gluconate IV
Dosing
- Mg toxicity
- 1 g (10 mL of 10%) slow IV over 10 min
- Hyperkalaemia
- 10 mL of 10% IV over 10 min
Contraindications
- AbsoluteHypercalcaemia, digoxin toxicity (worsens)
Side effects
- Hypotension if rapid
- Extravasation → tissue necrosis
Fetal & maternal notes
- • Safe.
Key interactions
Digoxin
AvoidArrhythmia
Ceftriaxone (neonate)
AvoidPrecipitation
Clinical pearls
- 💡 Keep at bedside during MgSO4 infusion.
- 💡 Calcium chloride only via central line.
Content last reviewed: REPLACE_ME (e.g. 2026-07)
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