This causes a change in the voltage of the cell membrane. First, high magnesium can cause calcium levels to drop in the body, which causes further problems with cellular functioning and requires replenishment of the calcium. Initially it increases myocardial excitability by raising the RMP from -90mv to approx -75mv; hence bringing it closer to the threshold potential. Widened QRS complex. Many of the side effects of calcium gluconate are similar to signs of elevated levels of calcium in the bloodstream (hypercalcemia). Your body needs potassium. Calcium Gluconate. Download as PDF. Supplementation may be done to treat or prevent osteoporosis or rickets. Calcium gluconate is most commonly used in emergency situations to treat several conditions. 18 The ECG changes 1, 21 include tall T waves … This is because the no of Na+ channels activated decreases if RMP becomes less negative. Pseudohyperkalemia refers to artificially elevated potassium due to: (a) Hemolysis. Plus, the complicated interplay between calcium, potassium, magnesium, and vitamin D make this a supplement that should be used with the advice of your physician. Options for IV Calcium treatment include Calcium Gluconate and Calcium Chloride – 10mls of Calcium Chloride has about 3 times more calcium ions than the equivalent dose of Calcium Gluconate; For more information on calcium – CLICK HERE. IV insulin (i.e. Occasionally when severe it can cause palpitations, muscle pain, muscle weakness, or numbness. Then insulin and glucose are given, which move potassium from blood into cells, thus lowering the potassium level in blood. Calcium gluconate is a mineral supplement and medication. Calcium gluconate should not be used in patients with digitalis toxicity because of an increased risk of developing arrhythmias. J Clin Endocrinol Metab. Your doctor may prescribe calcium gluconate to help control calcium levels depending on your condition. Blood pressure medications that are known as calcium channel blockers lower blood pressure by slowing down the ability of the calcium to react across muscle cell membranes. Calcium Gluconate. Oral calcium gluconate can also be used as a calcium supplement but is probably not be the best option for use as a long-term solution.. Cardiac glycoside therapy, however, does not preclude the use of calcium gluconate. Intravenous calcium gluconate (10 cc of 10% solution) was given and has changed the EKG immediately to the tracing below. Acute hypocalcemia can develop muscle spasms in the hands and feet, and large muscle or abdominal cramps. <3Wondering what do I write? It increases Vmax. Thank you, {{form.email}}, for signing up. 2. It will cause increased pH which will increase the activity of H+-K+ exchangers. Calcium Gluconate or Calcium Chloride. Continuous IV drip infusion can be administered between 5 to 20 milligrams per kilograms (mg/kg) per hour. 2005 Jun;313(3):1217-22. doi:10.1124/jpet.104.081893, Chhabra P, Rana SS, Sharma V, Sharma R, Bhasin DK. Hypoparathyroidism can lead to hypocalcemia, which can also be the first indication of hypoparathyroidism., Muscle contraction and nerve conduction rely on a proper balance of potassium and calcium in the blood and body tissues. Second, calcium treats the harmful effects magnesium has on the heart, nerves and muscles. Epidemiology and Diagnosis of Hypoparathyroidism. Acute (sudden) hyperkalemia (high levels of potassium in the blood) has essentially the same effect on muscle and nerve physiology as hypocalcemia. International Journal of Occupational Medicine and Environmental Health. Physiologic antagonists: 500 mg calcium chloride, or 1 gm calcium gluconate is enough to temporarily stabilize the heart from the effects of hyperkalemia. Discover free flashcards, games, and test prep activities designed to help you learn about Calcium Gluconate and other concepts. 7, 20 The sensitivity of emergency physicians diagnosing moderate to severe hyperkalaemia (K >6.5) from the ECG is only 62%. 2014;27(1):104-113. doi:10.2478/s13382-014-0225-4, Ⓒ 2021 About, Inc. (Dotdash) — All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Hyperkalemia is an elevated level of potassium (K +) in the blood. Both 1 and 2 work by increasing the activity of Na+-K+ ATPase. Hyperkalemia is a condition in which the levels of potassium in the bloodstream are abnormally high. C. 1 – 3, 27. There is no good literature to help guide whether calcium gluconate or calcium chloride is better for stabilizing the cardiac membrane in hyperkalemia. Bicarbonate. It stabilizes the cell membranes and is indicated to prevent arrhythmias in patients with hyperkalemia and EKG changes. Onset: Effect occurs in 1-3 minutes (anticipate EKG improvement within 3 minutes) By using Verywell Health, you accept our, Tricalcium Phosphate: Benefits, Side Effects, Dosage, and Interactions, Which Calcium Supplements Work Best and Why, Parathyroid: Anatomy, Location, and Function, Everything You Need to Know About Parathyroid Surgery, Tumor Lysis Syndrome Is a Cancer Emergency, Hypoparathyroidism: A Rare Cause of Low Calcium Levels, The Health Benefits of Calcium D-Glucarate. Myocardial excitability amended! Insulin and dextrose are frequently used to manage patients with hyperkalemia. J R Coll Physicians Lond. Instead, calcium gluconate is used to mitigate the signs and symptoms of low calcium levels or high potassium levels. The emergency physician will determine dosages for calcium gluconate based on the patient's signs and symptoms as well as through laboratory blood testing. It makes the threshold potential become less negative, thereby restoring the normal difference between it and RMP. This is express yourself space. doi:10.1210/jc.2015-3908, Palmer BF, Clegg DJ. Vitamin D deficiency and hypocalcemia are interrelated and often are treated together., A lack of parathyroid hormone (PTH) in the body is known as hypoparathyroidism. The use of intravenous calcium gluconate can help to balance the effects of the increased potassium. You are a brilliant mind. Rod Brouhard is an emergency medical technician paramedic (EMT-P), journalist, educator, and advocate for emergency medical service providers and patients. Usual Adult Dose for Exchange Transfusion: 300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min. Calcium Gluconate or Calcium Chloride. It does not lower the serum potassium level, but instead is used to stabilise the myocardium, as a temporising measure. Calcium gluconate should be the preferred calcium compound,80 giving 0.6mL/kg bolus of 10% it followed by an infusion at 0.6 to 1.5mL/kg per hour and titrating to … Cleve Clin J Med. Oral concentration tablets are available in 50 mg, 500 mg, and 650 mg, while oral concentration capsules are available in 500 mg. Calcium gluconate is not considered ideal for use as a dietary supplement. 1. Usual adult dose for exchange transfusion: 300 mg (3 ml) IV one time with each 100 ml of citrated blood at a rate, not to exceed 0.5 to 2 ml/min. Read our, Medically reviewed by Lana Butner, ND, LAc, Medically reviewed by Richard N. Fogoros, MD, Medically reviewed by Mohamad Hassan, PT, DPT, Medically reviewed by Ana Maria Kausel, MD, Medically reviewed by Kashif J. Piracha, MD, Medically reviewed by Jonathan Cluett, MD, Verywell Health uses cookies to provide you with a great user experience. 4- And finally, the downsloping, not so steep repolarization phase caused by K+ efflux via Ikr (Rapid delayed rectifier channels) and also a few other channels which you can afford to forget. This agent may also … 1- Very steep phase 0 caused by Na+ influx, Regarding this, what is the function of calcium gluconate? It is not well-suited to return low blood calcium levels to normal. 0.5 mL/kg IV (0.1 mmoL/kg) over 10-30 min. 2016;29(2):214–220. 3- Phase 2 plateau phase caused by Ca2+ influx and K+ efflux via slow delayed rectifier channels. Clinical arterial infusion of calcium gluconate: The preferred method for treating hydrofluoric acid burns of distal human limbs. From: Heart and Toxins, 2015. Calcium gluconate 1000 mg (10 mL of a 10% solution) IV infused over 2-3 minutes OR *Calcium chloride 500 to 1000 mg (5 to 10 mL of a 10% solution), also infused over 2-3 minutes < 3 min. However, this can also cause hyperkalemia because K+ ions are no longer being pumped into the cell. doi:10.20524/aog.2016.0015. Along with potassium and magnesium, calcium is essential for muscle contraction and nerve conduction. 2. Usual Adult Dose for Exchange Transfusion: 300 mg (3 mL) IV one time with each 100 mL of citrated blood at a rate not to exceed 0.5 to 2 mL/min. This movement of calcium out of the cell helps to repolarize the cell. This should be given first, and will be considered a cardio-protective measure. Hanzlik RP, Fowler SC, Fisher DH. Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis. Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia. [Note: Vmax is the rate of build-up of membrane potential in phase 0], 2- A short, sharp phase 1 caused by K+ efflux via Transient outward K+ channel It is not well-suited to return low blood calcium levels to normal. Antagonizes Hyperkalemia cardiac, neurologic effects. Calcium is a mineral element, and the most abundant mineral, found in the body. Background: Hyperkalemia is a common, potentially lethal clinical condition that accounts for a significant number of emergency department (ED) visits. Supplementation is generally only required when there is not enough calcium in the diet. Diagnosis and treatment of hyperkalemia. This blunts the "hyperexcitable" state of the heart (leading to lower likelihood of arrhythmia). Calcium gluconate is most commonly used in emergency situations to treat several conditions. Second, calcium treats the harmful effects magnesium has on the heart, nerves and muscles. Ann Gastroenterol. 2016;101(6):2284–2299. Calcium is indicated if there is widening of QRS, sine wave pattern (when S and T waves merge together), or in hyperkalaemic cardiac arrest. Now that we know what happens in Hyperkalemia, let us learn how calcium gluconate amends these changes. Calcium gluconate should be the preferred calcium compound,80 giving 0.6mL/kg bolus of 10% it followed by an infusion at 0.6 to 1.5mL/kg per hour and titrating to improve blood pressure and contractility. =DBe a good critic and correct us if something went wrong :|Go ahead. Other calcium salts … Supplementation may be done to treat or prevent osteoporosis or rickets. The dose of calcium gluconate may be repeated. Calcium is used medically in many forms, including calcium chloride, calcium formate, calcium citrate, or calcium gluconate. First of all, please form a mental image of normal cardiac action potential with the- 1- Very steep phase 0 caused by Na+ influx, To study the effect of specific beta 2-adrenergic stimulation on potassium metabolism in renal failure, we intravenously administered albuterol (Salbutamol) sulfate, 0.5 mg, to 20 patients with chronic renal failure (glomerular filtration rate, less than 5 mL/min) receiving maintenance hemodialysis. EKG after treatment shows reappearance of atrial fibrillation. ^__^Ask about something you don't understand @_@?Compliment... Say something nice! ( and some books say Cl- influx). There are many causes for hyperkalemia, mostly related to kidney disease because this organ helps control the levels of potassium in the body, and to hormonal causes. IV concentrations are usually 100 milligrams per milliliter (mg/ml) and commercially prepared. First, you give calcium gluconate to stabilize the cardiomyocyte membranes. Calcium gluconate is available over the counter as a dietary supplement, but there are better options to choose from. Ca gluconate antagonises cardiac membrane excitability and does not affect the plasma K. 1, 19 It is generally accepted that calcium should be given when there are ECG changes associated with hyperkalaemia. Cardiac glycosides and calcium gluconate both increase intracellular calcium, so calcium gluconate can worsen digitalis toxicity. It reduces the effectiveness of heart muscle tissue and lowers the blood pressure overall. Calcium is given intravenously to protect the heart, but calcium does not lower the potassium level. How does calcium help to stabilize the myocardium in hyperkalemia? This is because of a strange reason. It might need to come with magnesium or vitamin D to make the best use of it and that level of complexity really needs a physician to help you navigate it. SC: 10% calcium gluconate, no more than 0.5 mL/cm² of skin; do not use in digits. Includes dosages for Dietary Supplement, Hypocalcemia and Hyperkalemia… Arno Kroner, DAOM, LAc, is a board-certified acupuncturist, herbalist, and integrative medicine doctor practicing in Santa Monica, California. Calcium gluconate can be given either intravenously, orally, or topically. Insulin with Dextrose If topical and/or SC do not work, consider intra-arterial. Crit Care Med. Oral calcium is more likely to lead to adverse gastrointestinal effects. In this post I will try to explain why Calcium gluconate is the first line drug in managing hyperkalemia. Other IV preparations for drip infusion or pediatric administration can be diluted with normal saline or 5% dextrose solutions. Calcium Gluconate is the gluconate salt of calcium.An element or mineral necessary for normal nerve, muscle, and cardiac function, calcium as the gluconate salt helps to maintain calcium balance and prevent bone loss when taken orally. Patients with hyperkalemia and characteristic ECG changes should be given intravenous calcium gluconate. Clinical arterial infusion of calcium gluconate: The preferred method for treating hydrofluoric acid burns of distal human limbs. Calcium is ben-eficial even in patients who are normocalcemic. Calcium gluconate is a useful treatment for magnesium toxicity several reasons. How much is in one ampule? A word of caution! Let's put that another way. Calcium gluconate is sold as a calcium supplement, but other calcium preparations are better for maintaining healthy calcium levels in the body. Both were from a blood sample drawn 13 minutes prior to the following ECG (time zero): ECG time zero: There is a near sine wave which is pathognomonic for hyperkalemia. The use of calcium does not reduce the serum potassium level, but counteracts the effects of hyperkalemia on cardiac excitability. What You Need to Know About Calcium and Vitamin D Supplements, Relative bioavailability of calcium from calcium formate, calcium citrate, and calcium carbonate, Hypocalcemic tetany: a simple bedside marker of poor outcome in acute pancreatitis, Vitamin D and hyperparathyroidism: the Lumleian Lecture 1981, Epidemiology and Diagnosis of Hypoparathyroidism, Clinical arterial infusion of calcium gluconate: The preferred method for treating hydrofluoric acid burns of distal human limbs, Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults, Numbness and tingling in the fingers and toes. Ann Pharmacother 2016; 50:455. J Clin Endocrinol Metab. Should You Take Vitamin D for Fibromyalgia? 3. Calcium is indicated if there is widening of QRS, sine wave pattern (when S and T waves merge together), or in hyperkalaemic cardiac arrest. doi:10.1097/CCM.0000000000002087, Chhabra P, Rana SS, Sharma V, Sharma R, Bhasin DK. The use of calcium does not reduce the serum potassium level, but counteracts the effects of hyperkalemia on cardiac excitability. Experts Consensus Recommendations for the Management of Calcium Channel Blocker Poisoning in Adults. Sign up for our Health Tip of the Day newsletter, and receive daily tips that will help you live your healthiest life. Let's review everything, shall we? Beta-2 Agonists​ like Albuterol. The QRS axis and morphology after treatment are very much the same as those during hyperkalemia except the QRS is much narrower. Calcium will not reduce the serum potassium levels, but will prevent potential arrhythmias. Typical signs and symptoms of anaphylaxis include hives, itching, wheezing, shortness of breath, difficulty swallowing, confusion, low blood pressure, and loss of consciousness. IV calcium gluconate is typically administered with an initial loading dose (bolus) of 1 to 2 grams. Calcium gluconate is a mineral supplement and medication. Includes dosages for Dietary Supplement, Hypocalcemia and Hyperkalemia; plus … Ann Gastroenterol. Calcium. … 2016;29(2):214–220. Myocardial depression amended! Clarke BL, Brown EM, Collins MT, et al. J Pharmacol Exp Ther. SC: 10% calcium gluconate, no more than 0.5 mL/cm² of skin; do not use in digits. The most important difference to remember is that calcium chloride has 3 times more elemental calcium than calcium gluconate (6.8 mEq/10 mL vs 2.2 mEq/10 mL) and has greater bioavailability. Some patients report a chalky taste in the mouth after IV administration. There is no good literature to help guide whether calcium gluconate or calcium chloride is better for stabilizing the cardiac membrane in hyperkalemia. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. Therefore, when hyperkalemia is accompanied by hemodynamic compromise, calcium chloride is preferred to calcium gluconate. Further Calcium beyond first 1-2 doses are ineffective; No additional myocardial stabilization with further doses unless Hypocalcemia; Course. Intravenous calcium gluconate and calcium chloride are commonly used in emergency medicine. But as Hyperkalemia progresses, it causes myocardial depression by decreasing Vmax, essentially slowing down phase 0, hence causing increase in QRS complex duration. Detailed Calcium Gluconate dosage information for adults, the elderly and children. If topical and/or SC do not work, consider intra-arterial. Calcium Gluconate is the gluconate salt of calcium.An element or mineral necessary for normal nerve, muscle, and cardiac function, calcium as the gluconate salt helps to maintain calcium balance and prevent bone loss when taken orally. (b) Severe polycythemias causing potassium release during clotting (e.g., … They're customizable and designed to help you study and learn more effectively. doi:10.1210/jc.2015-3908, Zhang Y, Ni L, Wang X, et al. High potassium (called “hyperkalemia”) is a medical problem in which you have too much potassium in your blood. There are many causes for hyperkalemia, mostly related to kidney disease because this organ helps control the levels of potassium in the body, and to hormonal causes. Low calcium levels can also lead to irritable reflexes and cardiac dysrhythmias. We know that at this point the rising K + level has inactivated a large number of Na + channels. Comment all you like here! The use of mineral and vitamin supplements can be very beneficial but are not completely without risk. Discover free flashcards, games, and test prep activities designed to help you learn about Calcium Gluconate and other concepts. 3. Hyperkalemia (when serum potassium levels >5 mEq/L) can lead to various cardiac abnormalities and death, so the first step in management is to stop/prevent arrhythmia. International Journal of Occupational Medicine and Environmental Health. Haemodialysis if it's readily available. While managing Patient with hyperkalemia ,we administer sodium bicarbonate !how does it work , or mechanism in ... Get help with your research. They're customizable and designed to help you study and learn more effectively. Calcium does not cause intracellular Potassium influx, but it helps maintain the cell membrane AP threshold, the gradient between intracellular Potassium and extracellular Sodium, and vise versa. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. We give calcium to stabilize the cardiomyocyte during hyperkalemia. Rapid intravenous (IV) administration may lead to more severe immediate reactions than long-term oral dosing. What is hyperkalemia? Calcium Gluconate in Hyperkalemia Hey guys!! Evaluation of Sodium Polystyrene Sulfonate Dosing Strategies in the Inpatient Management of Hyperkalemia. By inhibiting the sodium-potassium pump, digoxin increases positive inotropy by keeping calcium ions inside the cell. This agent may also … It is an important nutrient that is found in many of the foods you eat. Additional doses of 1 to 2 grams IV bolus can be given every six hours. Clin … A question for you guys, Why is it recommended to give a laxative with an ion exchange resin? It does so by reducing the threshold potential of cardiac myocytes, thereby restoring the normal gradient with the resting mem-brane potential, which is distorted by hy-perkalemia (19, 20, 33). Calcium is ben-eficial even in patients who are normocalcemic. One of the first steps in a patient with hyperkalemia is to administer IV calcium before the patient transitions from peaked T waves to ventricular fibrillation. Subsequently, question is, how do you reverse hyperkalemia? First of all, please form a mental image of normal cardiac action potential with the- Absorption of elemental calcium (the actual mineral) is not as effective with calcium gluconate as it is with other types of calcium supplements.. EKG after treatment shows reappearance of atrial fibrillation. Potential adverse effects of calcium gluconate depend on the route of administration. Calcium gluconate, dextrose with insulin, salbutamol, sodium bicarbonate: Frequency ~2% (people in hospital) Hyperkalemia is an elevated level of potassium (K +) in the blood. Acute (sudden) hyperkalemia (high levels of potassium in the blood) has essentially the same effect on muscle and nerve physiology as hypocalcemia. Normal potassium levels are between 3.5 and 5.0 mmol/L (3.5 and 5.0 mEq/L) with levels above 5.5 mmol/L defined as hyperkalemia. Calcium gluconate is best used if the patient has a small, peripheral IV line and can tolerate waiting ~15 minutes for the dose to infuse. Epidemiology and Diagnosis of Hypoparathyroidism. This is a medication with clear clinical significance to treat certain medical conditions, but it is not that useful as a daily calcium supplement for things like bone health or to treat osteoporosis. Most emergency doses of calcium gluconate are given intravenously (IV), either as a bolus (single dose of medication given at one time and pushed directly into the IV line) or as a drip infusion given over time. 2017 Dec;84(12):934-942. doi:10.3949/ccjm.84a.17056, Zhang Y, Ni L, Wang X, et al. So in such conditions we use calcium gluconate cautiously only if- Ion exchange resins like Sodium Polystyrene Sulfonate along with a laxative like Sorbitol. Starting with good dietary choices is always the foundation for maintaining the right balance of electrolytes. 1. 4. Is this safe in digoxin toxicity, when there is already too much calcium inside the myocytes? The effect is transient, lasting 30-60 minute s. Constant cardiac monitoring is … There is loss of P waves Signs and symptoms of hypocalcemia depend on whether it is acute or chronic onset (came on quickly or over a long time period). Typically hyperkalemia does not cause symptoms. It is a foundation for bone structure and occurs naturally in several forms and in many foods. 2. Hagan AE, Farrington CA, Wall GC, Belz MM. Instead, calcium gluconate is used to mitigate the signs and symptoms of low calcium levels or high potassium levels. Intra-arterial calcium infusion for moderate to severe burns: Infuse 10 mL 10% calcium gluconate mixed with 40-50 mL D5W over 4 hours, repeating as needed (need to indicate with high-pressure pump) Calcium gluconate is a useful treatment for magnesium toxicity several reasons. In hyperkalemia, there is a shift of potassium from the intracellular compartment to the extracellular compartment (which is the bloodstream). Click to see full answer. It's well known that many people, especially postmenopausal women and those with osteoporosis, can use the extra calcium that supplements provide. The full story is complicated and ambiguous. 2. Intra-arterial calcium infusion for moderate to severe burns: Infuse 10 mL 10% calcium gluconate mixed with 40-50 mL D5W over 4 hours, repeating as needed (need to indicate with high-pressure pump) Intravenous calcium gluconate (10 cc of 10% solution) was given and has changed the EKG immediately to the tracing below. Check Interpret Media out if you are looking for an illustrator. This is given to prevent cardiac arrhythmias that may be caused by the high serum potassium. Actrapid) 10 units with 50ml of 50% dextrose into a good IV cannula The most important difference to remember is that calcium chloride has 3 times more elemental calcium than calcium gluconate (6.8 mEq/10 mL vs 2.2 mEq/10 mL) and has greater bioavailability. It does so by reducing the threshold potential of cardiac myocytes, thereby restoring the normal gradient with the resting mem-brane potential, which is distorted by hy-perkalemia (19, 20, 33). Conversely, it increases the rate of Repolarization, hence causing shortening of QT interval. Yes, you are! Chemical burns from hydrofluoric acid have reacted well to treatment with calcium gluconate. Use of a gel with calcium gluconate can be applied topically to a hydrofluoric acid burn. Administration of calcium gluconate is the main treatment for this condition. Stabilizing the cardiac membrane with calcium gluconate. ;). Correct Serious Conduction Abnormalities (Calcium) Calcium is a very useful agent. Hypocalcemic tetany is related to low calcium levels in the blood and can be a sign of acute pancreatitis., Vitamin D deficiency: A lack of vitamin D in the diet, renal failure or liver failure, and too little exposure to sunlight can all lead to vitamin D deficiency. But too much potassium in your blood can be dangerous. The following measures should also be … 2014;27(1):104-113. doi:10.2478/s13382-014-0225-4, St-Onge M, Anseeuw K, Cantrell FL, et al. Hypocalcemic tetany: Muscle spasms of the face, or of the hands and feet (known as carpal-pedal spasms). Sodium bicarbonate used to treatment hyperkalemia.Sodium bicarbonate works by increasing the movement of potassium from the blood into the cells.. The treatment of hyperkalemia can be 4 fold: 1.) Medicine. It does not lower the serum potassium level, but instead is used to stabilise the myocardium, as a temporising measure. (:PS: We have moderated comments to reduce spam. This agent may also be chemopreventive for colon and other cancers. Effect: Stabilizes myocardial membrane potential, should be given if the infant is at risk of, or has ECG changes and/or arrhythmias. The treatment of hyperkalemia can be 4 fold: 1.) 5. This patient had a K of 8.1 mEq/L and a very low ionized Calcium of 2.4 mg/dl (normal: 4.4 - 5.2). Calcium gluconate is also used as a cardioprotective agent in hyperkalemia. This should be given first, and will be considered a cardio-protective measure. As Marco says, calcium gluconate (the classical treatment to reduce cardiac muscle excitability in hyperkalaemia) does not affect the intra and extracellular concentrations of K+. Excellent decision… but WHY are you giving it? 3. This is coz of the K+ concentration gradient alteration. Tikrit University. Relative bioavailability of calcium from calcium formate, calcium citrate, and calcium carbonate.