Veterinary Drug Handbook (VDH) is the reference veterinarians turn to when they want an independent source of information on the drugs that are used in veterinary medicine today.


Doses - CALCIUM SALTS, CALCIUM GLUCONATE, CALCIUM GLUCEPTATE, CALCIUM CHLORIDE, CALCIUM LACTATE

Dogs:

For hypocalcemia:
a) Calcium gluconate injection: 94 - 140 mg/kg IV slowly to effect (intraperitoneal routemay also be used). Monitor respirations and cardiac rate and rhythm during administration. (USPC 1990)
b) For acute hypocalcemia: Calcium gluconate 10% injection: Warm to body temperatureand give IV at a rate of 50 - 150 mg/kg (0.5 - 1.5 ml/kg) over 20-30 minutes. Ifbradycardia develops, halt infusion. Following acute crisis infuse 10 - 15 ml (of a 10%solution) per kg over a 24 hour period. Long term therapy may be accomplished byincreasing dietary calcium and using vitamin D. Calcium lactate may be given orally at arate of 0.5 - 2 g/day. (Seeler and Thurmon 1985)
c) Calcium gluconate 10% 0.5 - 1.5 ml/kg or calcium chloride 10% 1.5 - 3.5 ml (total) IVslowly over 15 minutes; monitor heart rate or ECG during infusion. If ST segmentelevation or Q-T interval shortening occur, temporarily discontinue infusion and reinstate at a slower rate when resolved.
Maintenance therapy is dependent on cause of hypocalcemia. Hypoparathyroidism istreated with vitamin D analogs (refer to DHT monograph) with or without oral calciumsupplementation. (Russo and Lees 1986)
d) For emergency treatment of tetany and seizures secondary to hypoparathyroidism:
Calcium gluconate 10%: 0.5 - 1.5 ml/kg (up to 20 ml) over 15-30 minutes. May repeat at 6-8 hour intervals or give as continuous infusion at 10 - 15 mg/kg/hour. Monitor
ECG and stop infusion if S-T segment elevates, Q-T interval shortens, or arrhythmias occur.
For long-term therapy (with DHT¯refer to that monograph), calcium supplementation may occasionally be useful. Calcium gluconate at 500 - 750 mg/kg/day divided tid, or calcium lactate at 400 - 600 mg/kg/day divided tid, or calcium carbonate 100 - 150 mg/kg/day divided bid. Monitor serum calcium and adjust as necessary. (Kay and Richter 1988)
For hyperkalemic cardiotoxicity:
a) Secondary to uremic crisis: Correct metabolic acidosis, if present, with sodium bicarbonate (bicarbonate may also be beneficial even if acidosis not present). Calcium gluconate (10%) indicated if serum K+ is > 8 mEq/L. Give at an approximate dose of 0.5 - 1 ml/kg over 10-20 minutes; monitor ECG. Rapidly corrects arrhythmias but effects are very short (10-15 minutes). IV glucose (0.5 - 1 g/kg body weight with or without insulin) also beneficial in increasing intracellular K+ concentrations. (Polzin and Osborne 1985)

Cats:

For hypocalcemia:
a) Calcium gluconate injection: 94 - 140 mg/kg IV slowly to effect (intraperitoneal routemay also be used. Monitor respirations and cardiac rate and rhythm during administration. (USPC 1990)
b) For acute hypocalcemia secondary to hypoparathyroidism: Using 10% calcium gluconate injection, give 1 - 1.5 ml/kg IV slowly over 10-20 minutes. Monitor ECG ifpossible. If bradycardia, or Q-T interval shortening occurs, slow rate or temporarilydiscontinue. Once life-threatening signs are controlled, add calcium to IV fluids andadminister as a slow infusion at 60 - 90 mg/kg/day (of elemental calcium). This convertsto 2.5 ml/kg every 6-8 hours of 10% calcium gluconate. Carefully monitor serumcalcium (once to twice daily) during this period and adjust dose as required.
Begin oral calcium initially at 50 - 100 mg/kg/day divided 3-4 times daily of elementalcalcium and dihydrotachysterol once animal can tolerate oral therapy. Give DHTinitially at 0.125 - 0.25 mg PO per day for 2-3 days, then 0.08 - 0.125 mg per day for2-3 days and finally 0.05 mg PO per day until further dosage adjustments are necessary. As cat's serum calcium is stabilized, intravenous calcium may be reduced anddiscontinued if tolerated. Stable serum calcium levels (8.5-9.5 mg/dl) are usuallyachieved in about a week. Continue to monitor and adjust dosages of DHT and calciumto lowest levels to maintain normocalcemia. (Peterson and Randolph 1989) (Note: referto the DHT monograph for further information.)
c) For hypocalcemia secondary to phosphate enema toxicity or puerperal tetany: follow theguidelines for use of intravenous calcium in "b" above. (Peterson and Randolph 1989)

Cattle:

For hypocalcemia:
a) Calcium gluconate injection: 150 - 250 mg/kg IV slowly to effect (intraperitoneal routemay also be used). Monitor respirations and cardiac rate and rhythm duringadministration. (USPC 1990)
b) Calcium gluconate 23% injection: 250 - 500 ml IV slowly, or IM or SQ (divided andgiven in several locations, with massage at sites of injection). (Label directions; Calcium
Gluc. Injection 23%¯TechAmerica)
c) 8 - 12 grams of calcium IV infused over a 5-10 minute period; use a product containingmagnesium during the last month of pregnancy if subclinical hypomagnesemia isdetected. (Allen and Sansom 1986)

Horses:

For hypocalcemia:
a) Calcium gluconate injection: 150 - 250 mg/kg IV slowly to effect (intraperitoneal routemay also be used). Monitor respirations and cardiac rate and rhythm duringadministration. (USPC 1990)
b) Calcium gluconate 23% injection: 250 - 500 ml IV slowly, or IM or SQ (divided andgiven in several locations, with massage at sites of injection). (Label directions; Calcium
Gluconate Injection 23%¯TechAmerica)
c) For lactation tetany: 250 ml per 450 kg body weight of a standard commerciallyavailable solution that also contains magnesium and phosphorous IV slowly while ascultating heart. If no improvement after 10 minutes, repeat. Intensity in heart soundsshould be noted, with only an infrequent extrasystole. Stop infusion immediately if apronounced change in rate or rhythm is detected. (Brewer 1987)

Sheep & Goats:

For hypocalcemia:
a) Sheep: Calcium gluconate injection: 150 - 250 mg/kg IV slowly to effect (intraperitoneal route may also be used). Monitor respirations and cardiac rate and rhythm during administration. (USPC 1990)
b) Sheep: Calcium gluconate 23% injection: 25 - 50 ml IV slowly, or IM or SQ (divided and given in several locations, with massage at sites of injection). (Label directions;
Calcium Gluconate Injection 23%¯TechAmerica)

Swine:

For hypocalcemia:
a) Calcium gluconate injection: 150 - 250 mg/kg IV slowly to effect (intraperitoneal route may also be used). Monitor respirations and cardiac rate and rhythm duringadministration. (USPC 1990)
b) Calcium gluconate 23% injection: 25 - 50 ml IV slowly, or IM or SQ (divided and given in several locations, with massage at sites of injection). (Label directions; Calcium
Gluconate Injection 23%¯TechAmerica)

Birds:

For hypocalcemic tetany:
a) Calcium gluconate: 50 - 100 mg/kg IV slowly to effect; may be diluted and given IM if a vein cannot be located. (Clubb 1986)
For egg-bound birds:
a) Initially, calcium gluconate 1% solution 0.01 - 0.02 ml/g IM. Provide moist heat (80-85°F) and allow 24 hours for bird to pass egg. (Nye 1986)

Reptiles:

a) For egg binding in combination with oxytocin (oxytocin: 1 - 10 IU/kg IM.): Calciumglubionate: 10 -50 mg/kg IM as needed until calcium levels back to normal or eggbinding is resolved. Use care when giving multiple injections. Calcium/oxytocin is notas effective in lizards as in other species. (Gauvin 1993)
Monitoring Parameters -
  • 1) Serum calcium
  • 2) Serum magnesium, phosphate, and potassium when indicated
  • 3) Serum PTH (parathormone) if indicated
  • 4) Renal function tests initially and as required
  • 5) ECG during intravenous calcium therapy if possible
  • 6) Urine calcium if hypercalcuria develops
    Dosage Forms/Preparations/FDA Approval Status/Withholding Times - Veterinary-Approved Products (not necessarily a complete list)
    Parenteral Products:
    Calcium Gluconate (as calcium borogluconate) 23% [230 mg/ml; 20.7 mg (1.06 mEq) calciumper ml]; in 500 ml bottles; Generic; (Rx) Depending on the product, approved for use in cattle, horses, swine, sheep, cats, and dogs. No withdrawal times are required.
    Products are also available that include calcium, phosphorus, potassium and/or dextrose; refer to theindividual product's labeling for specific dosage information. Trade names for these productsinclude: Norcalciphos®¯SKB, and Cal-Dextro® Special, #2, C, & K¯Fort Dodge. They arelegend (Rx) drugs.
    Oral Products: No products containing only calcium (as a salt) are available commercially withveterinary labeling. There are several products (e.g., Pet-Cal® and Osteoform® Improved) thatcontain calcium with phosphorous and vitamin D (plus other ingredients in some preparations).
    Parenteral Products:
    Calcium Gluconate Injection 10% [100 mg/ml; 9 mg (0.47 mEq) calcium per ml] in 10 ml amps, 10 & 50 ml, 100 ml, & 200 ml vials; Generic; (Rx)
    Calcium Chloride Injection 10% [100 mg/ml; 27.2 mg (1.36 mEq) calcium per ml] in 10 mlamps, vials, and syringes; Generic; (Rx)
    Calcium Gluceptate Injection 1.1 g/5 ml in 5 ml amps and 5 ml fill in 10 ml vial; Calcium
    Gluceptate® (Abbott) (Rx)
    Oral Products:
    Calcium Gluconate (9% calcium) Tablets: 500 mg (45 mg of calcium), 650 mg (58.5 mg ofcalcium), 975 mg (87.75 mg calcium), 1 gram (90 mg of calcium); Generic; (OTC)
    Calcium Lactate (13% calcium) Tablets: 325 mg (42.25 mg calcium), 650 mg (84.5 mg calcium);
    Generic; (OTC)
    Also available are calcium glubionate syrup, calcium carbonate tablets, suspension & capsules, calcium citrate tablets, dibasic calcium phosphate dihydrate tablets, and tricalcium phosphate tablets.
    Camphorated Tincture of Opium ¯ See Paregoric

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