From the Guidelines
An ionized calcium level of 1.14 mmol/L is within the normal range and does not require correction, as the normal range of ionised calcium is 1.1–1.3 mmol/L, according to the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition 1.
Clinical Context
When evaluating the need to correct an ionized calcium level, it's essential to consider the patient's clinical context, including symptoms and underlying conditions. However, in the absence of symptoms suggestive of hypocalcemia or conditions that put the patient at risk for calcium abnormalities, a level of 1.14 mmol/L can be considered normal.
Correction Thresholds
The guideline suggests that transfusion-induced hypocalcaemia, with ionised Ca2+ levels below 0.9 mmol/L, should be corrected promptly 1. Since the patient's ionized calcium level is 1.14 mmol/L, which is above this threshold, correction is not indicated based on the current evidence.
Preferred Correction Agent
If correction were necessary, the preferred agent would be calcium chloride, due to its higher elemental calcium content compared to calcium gluconate 1. However, this is not relevant in this case, given that the ionized calcium level does not require correction.
Clinical Decision
The decision not to correct an ionized calcium level of 1.14 mmol/L is based on the guideline's recommendation and the patient's level being within the normal range 1. It is crucial to monitor the patient's clinical status and adjust the management plan as necessary, but based on the provided information, correction of the ionized calcium level is not warranted.
From the FDA Drug Label
The usual adult dosage in hypocalcemic disorders ranges from 200 mg to 1 g (2 -10 mL) at intervals of 1 to 3 days depending on the response of the patient and/or results of serum ionized calcium determinations. Ionized calcium concentrations should be measured, to assist in dosage adjustment
The ionized calcium level of 1.14 is lower than the normal range, which typically ranges from 1.16 to 1.32 mmol/L.
- Correction is needed for this ionized calcium level.
- The dosage of calcium chloride can be adjusted based on the patient's response and serum ionized calcium levels, as stated in the drug label 2.
- It is recommended to administer 200 mg to 1 g of calcium chloride at intervals of 1 to 3 days, depending on the patient's response and serum ionized calcium levels.
From the Research
Ionized Calcium Correction
- The decision to correct an ionized calcium level of 1.14 mmol/L depends on various factors, including the patient's clinical condition and the presence of symptoms 3, 4, 5, 6.
- According to a study published in 2013, an ionized calcium level of less than 1 mmol/L was associated with increased mortality in patients with acute kidney injury 3.
- Another study published in 2020 found that hypocalcemia can cause a range of symptoms, from asymptomatic to life-threatening conditions, and that intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 4.
- A 2015 study found that hypocalcemia is highly prevalent in hemodialysis patients and is poorly predicted by albumin-corrected calcium levels 5.
- A 2021 study found that hypocalcemia is associated with worse neurological outcome at discharge and development of early hydrocephalus in endovascularly treated patients with spontaneous subarachnoid hemorrhage 6.
Clinical Considerations
- The patient's clinical condition, including the presence of symptoms such as muscle cramps, tetany, or seizures, should be taken into account when deciding whether to correct an ionized calcium level of 1.14 mmol/L 4.
- The patient's underlying medical condition, such as acute kidney injury or spontaneous subarachnoid hemorrhage, should also be considered when making this decision 3, 6.
- The potential risks and benefits of correcting an ionized calcium level of 1.14 mmol/L should be carefully weighed, including the risk of overcorrection and the potential for adverse effects 7, 4.