Calcium gluconate — FY prescribing 💊
🚨 HIGH ALERT — EDUCATIONAL DRAFT, NOT A PRESCRIBING ORDER. Drug choice, indication, formulation, dose, route and monitoring require current BNF/BNFC, product SmPC and local NHS protocol. Source reviewed 3 November 2026; independent clinical/pharmacy sign-off pending.
🧬 Mechanism and reason for use
- Intravenous calcium gluconate stabilises cardiac membrane excitability in hyperkalaemia but does NOT remove potassium from the circulation.
- Emergency cardioprotection for severe hyperkalaemia with ECG changes; separate uses for hypocalcaemia and other indications.
💊 Indication-specific UK regimen / dosing boundary
- Adult severe hyperkalaemia with ECG changes (not cardiac arrest): RCUK 2025 / MHRA specify 30 mL of calcium gluconate 10% IV over 10 minutes (6.8 mmol elemental calcium).
- In hyperkalaemic cardiac arrest, RCUK favours calcium chloride 10%, 10 mL IV under ALS; do not confuse equivalent volumes between salts.
- This is NOT the universal dose for every calcium-replacement indication.
🔎 Before writing a prescription
- Confirm calcium salt, concentration and volume; obtain ECG, serum potassium and renal function, coordinate with the hyperkalaemia pathway.
🧪 Monitoring and reassessment
- Continuous ECG, response of ECG changes; repeat calcium only under protocol and give potassium-shifting/removal measures concurrently.
🚨 Serious pitfalls / when to escalate
- 10 mL calcium gluconate 10% is not equivalent to 10 mL calcium chloride 10%; MHRA warned of underdosing.
- Calcium improves electrical stability, not potassium concentration.
📖 UK reference documents
Editorial status: Source checked for the specific statements above on 3 November 2026. References may be updated. This card has not had formal independent pharmacist/consultant approval; no unlisted indications, paediatric extrapolation or automatic renal-dose adjustments are implied.
