From the Guidelines
Treatment for Hypocalcemia
Hypocalcemia should be treated with calcium supplementation and vitamin D therapy.
- The initial treatment typically involves administering calcium chloride as the preferred agent due to its higher elemental calcium content compared to calcium gluconate 1.
- Calcium gluconate 10-20 mL of 10% solution can be administered intravenously over 10-15 minutes, followed by a continuous infusion of 0.5-2 mg/kg/hour 1.
- Oral calcium supplements such as calcium carbonate 500-1000 mg three times a day can also be given.
- Additionally, vitamin D therapy with ergocalciferol 50,000 IU orally once a week for 8 weeks or cholecalciferol 1000-2000 IU orally daily can be initiated.
- Magnesium levels should also be checked and supplemented if necessary, as magnesium deficiency can exacerbate hypocalcemia 1.
- Close monitoring of calcium and magnesium levels is essential to adjust the treatment accordingly.
- In severe cases, hospitalization may be required for close monitoring and intravenous therapy.
- It is also important to note that over-correction can result in iatrogenic hypercalcemia, renal calculi, and renal failure, so caution is advised 1.
From the FDA Drug Label
Calcium Gluconate Injection is a form of calcium indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia. Calcium Gluconate Injection is indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia.
The treatment for hypocalcemia (low calcium levels) is Calcium Gluconate Injection, which is administered intravenously. The dose should be individualized based on the severity of symptoms, serum calcium level, and acuity of onset of hypocalcemia. Key considerations include:
- Dilution: with 5% dextrose or normal saline
- Administration rate: slow infusion with careful ECG monitoring
- Monitoring: serum calcium levels every 4 to 6 hours during intermittent infusions and every 1 to 4 hours during continuous infusion 2 2
From the Research
Treatment Options for Hypocalcemia
The treatment for hypocalcemia (low calcium levels) varies depending on the underlying disorder and the severity of the condition.
- For acute hypocalcemia, intravenous administration of calcium gluconate can rapidly resolve symptoms such as neuromuscular irritability, tetany, and seizures 3, 4, 5.
- For chronic hypocalcemia, treatment options include oral calcium and vitamin D supplementation, which is the most frequently used treatment 5, 6.
- In patients with hypoparathyroidism, calcium and vitamin D supplementation must be carefully titrated to avoid symptoms of hypocalcemia while keeping serum calcium in the low-normal range to minimize hypercalciuria, which can lead to renal dysfunction 3.
- Recombinant human parathyroid hormone (rhPTH) has been approved for the treatment of hypoparathyroidism and has been shown to be effective in correcting serum calcium levels and reducing the daily requirements of calcium and active vitamin D supplements 5.
- Routine postoperative calcium and vitamin D supplementation therapy may be useful for the prevention of symptomatic hypocalcemia after total thyroidectomy and may allow for a safe and early discharge from the hospital 7.
Management of Chronic Hypocalcemia
The management of chronic hypocalcemia requires knowledge of the factors that influence the complex regulatory axes of calcium homeostasis in a given disorder.
- Treatment can be further intensified with thiazide diuretics, phosphate binders, and a low-salt and low-phosphorus diet when treating hypocalcemia secondary to hypoparathyroidism 6.
- Family physicians play a crucial role in educating patients about the long-term management and complications of hypocalcemia 6.
- Current therapy is limited by serum calcium fluctuations, and complications of current therapies for hypoparathyroidism include hypercalciuria, nephrocalcinosis, renal impairment, and soft tissue calcification 6.