Calcium Salts
Calcium gluconate, Calcium chloride, Calcium lactate, Calcium gluceptate
Also known as: AmTech Calcium Gluconate · Cal-Nate 1069 · Cal Supreme Gel · Clearcal 50 · Pet-Cal · Osteoform · Calcium borogluconate · Calcium glubionate
Reviewed by the VetSheet Veterinary TeamUpdated Apr 5, 2026Evidence-based veterinary reference
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Dosing by species
🌎 NA — North America🌍 EU — Europe
Dogs
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 94-140 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Acute hypocalcemia | Calcium gluconate 10% injection: Warm to body temperature and give IV at a rate of 50-150 mg/kg (0.5-1.5 mL/kg) over 20-30 minutes. Following acute crisis, infuse 10-15 mL (of a 10% solution) per kg over a 24-hour period. Long-term therapy: Calcium lactate 0.5-2 g/day. | IV/PO | PRN/Daily | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 10% 0.5-1.5 mL/kg or calcium chloride 10% 1.5-3.5 mL (total) IV slowly over 15 minutes | IV | PRN | — | 🌎 NA |
| 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. Long-term oral: Calcium gluconate at 500-750 mg/kg/day divided three times daily, or calcium lactate at 400-600 mg/kg/day divided three times daily, or calcium carbonate 100-150 mg/kg/day divided twice daily. | IV/PO | q6-8h or CRI | — | 🌎 NA |
| Emergency treatment of hypocalcemia | Calcium gluconate 10% 5-15 mg/kg (0.5-1.5 mL/kg) slowly to effect over a ten minute period, or calcium chloride 10% 5-15 mg/kg (0.15-0.5 mL/kg). Short-term treatment immediately after correction of tetany: CRI of calcium gluconate 10% at 60-90 mg/kg/day (6.5-9.75 mL/kg/day) added to fluids or give daily dosage SC in 3-4 divided doses per day after diluting with equal volume of saline. | IV/SC | PRN/CRI/Divided | — | 🌎 NA |
| Hyperkalemic cardiotoxicity (secondary to uremic crisis) | 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 | IV | PRN | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm during administration.
- Acute hypocalcemia: If bradycardia develops, halt infusion.
- Hypocalcemia: Monitor heart rate or ECG during infusion. If ST segment elevation or Q-T interval shortening occur, temporarily discontinue.
- Emergency treatment of tetany and seizures secondary to hypoparathyroidism: Monitor ECG and stop infusion if S-T segment elevates, Q-T interval shortens, or arrhythmias occur.
- Emergency treatment of hypocalcemia: Calcium chloride is extremely caustic if administered extravascularly.
- Hyperkalemic cardiotoxicity (secondary to uremic crisis): Monitor ECG. Rapidly corrects arrhythmias but effects are very short (10-15 minutes).
Cats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 94-140 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Acute hypocalcemia secondary to hypoparathyroidism | 10% calcium gluconate injection, give 1-1.5 mL/kg IV slowly over 10-20 minutes. Once controlled, add to IV fluids as slow infusion at 60-90 mg/kg/day (of elemental calcium) [converts to 2.5 mL/kg every 6-8 hours of 10% calcium gluconate]. Oral: initially 50-100 mg/kg/day divided 3-4 times daily of elemental calcium. | IV/PO | PRN/CRI/Divided | — | 🌎 NA |
| Hypocalcemia secondary to phosphate enema toxicity or puerperal tetany | 10% calcium gluconate injection, give 1-1.5 mL/kg IV slowly over 10-20 minutes. | IV | PRN | — | 🌎 NA |
| Emergency treatment of hypocalcemia | Calcium gluconate 10% 5-15 mg/kg (0.5-1.5 mL/kg) slowly to effect over a ten minute period, or calcium chloride 10% 5-15 mg/kg (0.15-0.5 mL/kg). Short-term treatment immediately after correction of tetany: CRI of calcium gluconate 10% at 60-90 mg/kg/day (6.5-9.75 mL/kg/day) added to fluids or give daily dosage SC in 3-4 divided doses per day after diluting with equal volume of saline. | IV/SC | PRN/CRI/Divided | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
- Acute hypocalcemia secondary to hypoparathyroidism: Monitor ECG. If bradycardia or Q-T interval shortening occurs, slow rate or temporarily discontinue.
- Hypocalcemia secondary to phosphate enema toxicity or puerperal tetany: Follow guidelines for use of intravenous calcium.
- Emergency treatment of hypocalcemia: Monitor heart rate or ECG.
Birds
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemic tetany | Calcium gluconate: 50-100 mg/kg IV slowly to effect; may be diluted and given IM if a vein cannot be located | IV/IM | PRN | — | 🌎 NA |
| Egg-bound birds | Initially, calcium gluconate 1% solution 0.01-0.02 mL/g IM. | IM | Once initially | — | 🌎 NA |
- Egg-bound birds: Provide moist heat (80-85°F) and allow 24 hours for bird to pass egg.
Reptiles
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Egg binding (in combination with oxytocin) | Calcium glubionate: 10-50 mg/kg IM as needed until calcium levels back to normal or egg binding is resolved. | IM | PRN | — | 🌎 NA |
- Egg binding (in combination with oxytocin): Use care when giving multiple injections. Calcium/oxytocin is not as effective in lizards as in other species.
Horses
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 150-250 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 23% injection: 250-500 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) | IV/IM/SC | PRN | — | 🌎 NA |
| Lactation tetany | 250 mL per 450 kg body weight of a standard commercially available solution that also contains magnesium and phosphorous IV slowly | IV | PRN | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
- Lactation tetany: Auscultate heart. If no improvement after 10 minutes, repeat. Stop infusion immediately if a pronounced change in rate or rhythm is detected.
Cattle
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 150-250 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 23% injection: 250-500 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) | IV/IM/SC | PRN | — | 🌎 NA |
| Hypocalcemia | 8-12 grams of calcium IV infused over a 5-10 minute period | IV | PRN | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
- Hypocalcemia: Use a product containing magnesium during the last month of pregnancy if subclinical hypomagnesemia is detected.
Swine
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 150-250 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 23% injection: 25-50 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) | IV/IM/SC | PRN | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
Sheep
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 150-250 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 23% injection: 25-50 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) | IV/IM/SC | PRN | — | 🌎 NA |
- Hypocalcemia: Intraperitoneal route may also be used. Monitor respirations and cardiac rate and rhythm.
Goats
| Indication | Dose | Route | Frequency | Duration | Region |
|---|---|---|---|---|---|
| Hypocalcemia | 150-250 mg/kg IV slowly to effect | IV | PRN | — | 🌎 NA |
| Hypocalcemia | Calcium gluconate 23% injection: 25-50 mL IV slowly, or IM or SC (divided and given in several locations, with massage at sites of injection) | IV/IM/SC | PRN | — | 🌎 NA |
- Hypocalcemia: Dosing extrapolated from sheep guidelines. Intraperitoneal route may also be used.
- Hypocalcemia: Dosing extrapolated from sheep guidelines.
Doses are a clinical reference for licensed veterinary professionals. Always confirm against the current label and the individual patient.
Overview
Calcium salts are essential mineral supplements used primarily to treat or prevent hypocalcemia and as oral phosphorus-binding agents in patients with renal failure.
Parenteral calcium is a critical emergency drug used for:
- Documented ionized hypocalcemia (e.g., eclampsia/puerperal tetany, primary hypoparathyroidism).
- Hyperkalemic cardiotoxicity (e.g., blocked cats, Addisonian crisis). Clinical Pearl: Calcium does not lower serum potassium; rather, it raises the threshold potential of the myocardium, restoring the normal resting-to-threshold gap and protecting the heart from fatal arrhythmias.
- Calcium channel blocker toxicity.
Clinical Pearl: It is crucial to distinguish between calcium salts. Calcium chloride 10% contains approximately three times the amount of elemental calcium (27.2 mg/mL) compared to Calcium gluconate 10% (9.3 mg/mL). Calcium chloride is highly irritating, acidifying, and carries a severe risk of tissue necrosis if extravasated; it should ideally be given via a central line. Calcium gluconate is the preferred salt for peripheral IV administration.
Mechanism of action
Calcium is an essential intracellular and extracellular cation vital for numerous physiological processes:
- Nervous and Musculoskeletal Function: Facilitates excitation-contraction coupling in cardiac and smooth muscle, and is required for neurotransmitter release at synaptic clefts.
- Cell Membrane Permeability: Maintains cell membrane integrity and capillary permeability.
- Enzymatic Reactions: Acts as a crucial cofactor for various enzymatic reactions and the coagulation cascade.
- Hyperkalemia Antagonism: In hyperkalemia, elevated resting membrane potentials lead to cardiac conduction blocks. Calcium administration → raises the threshold potential → restores the normal electrical gradient → stabilizes the myocardium.
Safety & warnings
Contraindications
- Ventricular fibrillation
- Hypercalcemia
Adverse effects
- Hypercalcemia
- GI irritation and/or constipation (oral administration)
- Mild to severe tissue reactions, pyogranulomatous panniculitis, adipocyte mineralization (IM or SC administration)
- Venous irritation (IV administration)
- Hypotension (if given IV too rapidly)
- Cardiac arrhythmias and cardiac arrest (if given IV too rapidly)
Precautions
WARNING: Intravenous calcium must be administered SLOWLY while continuously monitoring the ECG and/or heart rate. Too rapid administration can cause fatal arrhythmias, bradycardia, hypotension, and cardiac arrest. If bradycardia or Q-T interval shortening occurs, halt the infusion immediately.
- Extravasation Risk: Calcium salts (especially calcium chloride) are highly irritating. Perivascular administration can cause severe tissue necrosis. If extravasation occurs, stop infusion, infiltrate with normal saline, apply heat, and consider local corticosteroids or 1% procaine/hyaluronidase.
- Subcutaneous Use: While historically used SC in dogs/cats, it is now known to cause severe tissue reactions (pyogranulomatous panniculitis, mineralization) and should be used with extreme caution or avoided if possible.
- Acid-Base/Renal: Calcium chloride is acidifying; use with caution in respiratory failure, respiratory acidosis, or renal disease.
Drug interactions
Intravenous calcium may antagonize the effects of calcium-channel blocking agents.
Patients on digitalis therapy are more apt to develop arrhythmias if receiving IV calcium; use with extreme caution.
May lead to increased serum magnesium and/or calcium, particularly in patients with renal failure.
Parenteral calcium can neutralize the effects of hypermagnesemia or magnesium toxicity secondary to parenteral magnesium sulfate.
Parenteral calcium may reverse the effects of nondepolarizing neuromuscular blocking agents; has been reported to prolong or enhance the effects of tubocurarine.
Oral calcium can reduce the amount of these antibiotics absorbed from the GI tract via chelation; separate dosages by at least two hours.
Patients receiving both parenteral calcium and potassium supplementation may have an increased chance of developing cardiac arrhythmias.
Used in conjunction with large doses of calcium may cause hypercalcemia.
Excessive intake may stimulate calcium loss from bone and cause hypercalcemia.
Concurrent use of large doses of vitamin D or its analogs may cause enhanced calcium absorption and induce hypercalcemia.
Monitoring
- Serum calcium (total and ionized)
- Serum magnesium, phosphate, and potassium
- Serum PTH (parathormone) if indicated
- Renal function tests
- ECG and heart rate (continuously during IV therapy)
- Urine calcium (if hypercalciuria develops)
Pharmacokinetics
Absorption
Absorbed in the small intestine in the ionized form only. Requires active Vitamin D and an acidic pH for oral absorption. Parathormone (PTH) increases absorption in deficiency states. Dietary factors (high fiber, phytates), age, and certain drugs/diseases can reduce absorption.
Distribution
Approximately 99% of total body calcium is found in bone. Of circulating calcium, ~50% is bound to serum proteins (primarily albumin) or complexed with anions, and ~50% is in the active ionized form. Crosses the placenta and is distributed into milk.
Metabolism
Ionized calcium enters the extracellular fluid and is rapidly incorporated into skeletal tissue.
Elimination
Eliminated primarily in the feces (unabsorbed calcium + calcium excreted into bile and pancreatic juice). Small amounts are excreted in the urine (most filtered calcium is reabsorbed by the tubules and ascending loop of Henle).
Overdose
Oral overdoses of calcium-containing products are unlikely to cause hypercalcemia unless other drugs (e.g., Vitamin D) are given concurrently that enhance absorption.
Hypercalcemia can occur with parenteral therapy or oral therapy combined with Vitamin D or increased PTH levels.
- Mild hypercalcemia: Generally resolves without intervention when renal function is adequate. Withhold calcium therapy and Vitamin D analogs.
- Serious hypercalcemia (>12 mg/dL): Treat by hydrating with IV normal saline and administering a loop diuretic (e.g., furosemide) to increase sodium and calcium excretion. Monitor and replace potassium and magnesium as necessary. Monitor ECG. Corticosteroids, calcitonin, and hemodialysis may also be employed.
Available products
Formulations
- Injection: 10% and 23% solutions
- Oral tablets
- Oral capsules
- Oral powder
- Oral gel/paste
Veterinary
- Calcium Gluconate 23% Injection (230 mg/mL)
- Cal Supreme Gel (40-42 g calcium/300 mL tube)
- Clearcal 50 (Calcium Chloride 35% w/w or 47% w/v)
Human-labeled
- Calcium Gluconate Injection 10% (100 mg/mL)
- Calcium Chloride Injection 10% (100 mg/mL)
- Calcium Gluconate Tablets (500 mg, 648 mg, 650 mg, 972 mg, 975 mg)
- Calcium Gluconate Oral Powder
- Calcium Gluconate Capsules (500 mg, 700 mg)
- Calcium Lactate Tablets (648 mg to 650 mg)
Regulatory status
No regulatory data for: 🇺🇸 US · 🇪🇺 EU · 🇬🇧 UK · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Storage & stability
Store oral tablets and capsules in tight, well-closed containers at room temperature. Store injectable solutions at room temperature and protect from freezing.
Client information
For Pet Owners
- Purpose: Calcium supplements are used to treat low blood calcium levels, which can cause muscle twitching, weakness, or seizures (especially in nursing mothers, a condition called eclampsia or 'milk fever').
- Administration: If giving oral calcium, follow your veterinarian's instructions exactly. Do not give with certain antibiotics (like tetracyclines or fluoroquinolones) as calcium can block their absorption. Separate doses by at least 2 hours.
- Side Effects: Oral calcium can sometimes cause stomach upset or constipation.
- Warning: Never give human calcium supplements or antacids without consulting your veterinarian, as the dose and formulation may not be safe for your pet. If your pet is receiving injectable calcium at the clinic, they will be closely monitored, as giving it too fast can affect the heart.
VetSheet drug reference is intended for licensed veterinary professionals as a clinical decision-support aid, not a substitute for professional judgement or the manufacturer’s current label.