Hypocalcemia Management
Hypocalcemia
Definition
- Serum Ca < 8.5 mg/dL
- Chronic/Mildly Symptomatic: Ca > 7.5 mg/dL
- Acute/Symptomatic: Ca ? 7.5 mg/dL
Symptoms and Causes
- Symptoms may include muscle spasms, tingling, lethargy, seizures, and QT interval prolongation.
- Common causes include hypoparathyroidism, vitamin D deficiency and chronic kidney disease.
Cchronic/mild cases
- Oral Calcium Supplementation: 1-2 g of calcium gluconate daily, divided doses
- Monitor serum calcium weekly
Acute/symptomatic cases
- Intravenous Calcium Supplementation: IV bolus 1-2 g calcium gluconate
- Followed by 1000 ml infusion of 1 mg/ml elemental calcium at 50mg/hr
Monitoring
- Measure Serum Calcium levels daily
- Switch to oral calcium post-stabilization
Additional Considerations
- Initiate calcitriol with oral calcium for hypoparathyroidism
- Correct hypomagnesemia
References
- Mantovani G, Bastepe M, Monk D, et al. Recommendations for Diagnosis and Treatment of Pseudohypoparathyroidism and Related Disorders: An Updated Practical Tool for Physicians and Patients. Horm Res Paediatr 2020; 93:182.
- Schafer AL, Shoback DM. Hypocalcemia: Definition, Etiology, Pathogenesis, Diagnosis, and Management. In: Primer on the Metabolic Bone Diseases and Disorders of Mineral Metabolism, 9th, Bilezikian JP (Ed), American Society for Bone and Mineral Research, Hoboken, NJ 2018. p.646.
- Turner J, Gittoes N, Selby P. SOCIETY FOR ENDOCRINOLOGY ENDOCRINE EMERGENCY GUIDANCE: Emergency management of acute hypocalcaemia in adult patients. Endocrine Connections. 2016;5(5):G7-G8. doi:10.1530/EC-16-0056