From the Guidelines
Hypocalcemia should be treated with calcium supplementation, using oral calcium carbonate or calcium citrate (1-3g elemental calcium daily in divided doses) for mild to moderate cases, and intravenous calcium gluconate for severe symptomatic cases, while also addressing the underlying cause, such as hypoparathyroidism or vitamin D deficiency, as evidenced by studies 1.
Types of Hypocalcemia
- Acute hypocalcemia: often post-surgical or critical illness-related
- Chronic hypocalcemia: from hypoparathyroidism or vitamin D deficiency
- Medication-induced hypocalcemia
Treatment Approaches
- Calcium supplementation: oral calcium carbonate or calcium citrate (1-3g elemental calcium daily in divided doses) for mild to moderate cases
- Intravenous calcium gluconate 1-2g (10-20mL of 10% solution) for severe symptomatic hypocalcemia (tetany, seizures, or QT prolongation)
- Vitamin D supplementation: essential for long-term management, typically using calcitriol (0.25-1mcg daily) for active vitamin D or ergocalciferol/cholecalciferol (50,000 IU weekly to daily) for vitamin D deficiency
- Magnesium replacement: necessary if hypomagnesemia is present, as it can impair parathyroid hormone function
Chronic Management
- Regular monitoring of serum calcium, phosphate, and urinary calcium: important to prevent complications like hypercalciuria or nephrocalcinosis
- Goal of treatment: maintain serum calcium in the low-normal range while addressing the underlying cause
Underlying Causes
- Hypoparathyroidism
- Vitamin D deficiency
- Medication-induced hypocalcemia
- Other medical conditions, such as chronic kidney disease, as discussed in studies 1
Important Considerations
- Treatment should be individualized based on the underlying cause and severity of hypocalcemia
- Regular monitoring and adjustments to treatment are necessary to prevent complications and maintain optimal serum calcium levels, as recommended in study 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. The safety and effectiveness of Calcium Gluconate Injection have been established in pediatric patients for the treatment of acute, symptomatic hypocalcemia. 10% Calcium Chloride Injection, USP is indicated for the treatment of hypocalcemia in those conditions requiring a prompt increase in plasma calcium levels.
The types of hypocalcemia that can be treated with calcium gluconate or calcium chloride include acute symptomatic hypocalcemia. The treatment for hypocalcemia includes:
- Calcium gluconate injection for pediatric and adult patients
- Calcium chloride injection for conditions requiring a prompt increase in plasma calcium levels Key considerations for treatment include:
- Dose individualization based on the severity of symptoms, serum calcium level, and acuity of onset
- Monitoring of serum calcium levels during treatment
- Contraindications, such as hypercalcemia and concomitant use of ceftriaxone in neonates 2, 2
- Warnings and precautions, such as risk of tissue necrosis and calcinosis, and potential for aluminum toxicity 2, 2
From the Research
Types of Hypocalcemia
- Hypocalcemia can be caused by various disorders, including hypoparathyroidism, which is characterized by impaired secretion of parathyroid hormone (PTH) 3
- Disorders that disrupt the metabolism of vitamin D can also lead to chronic hypocalcemia, as vitamin D is responsible for increasing the gut absorption of dietary calcium 3
- Hypocalcemia can be divided into PTH and non-PTH mediated forms, with postsurgical hypoparathyroidism being the most frequent cause of hypocalcemia 4
Symptoms of Hypocalcemia
- Symptoms of acute hypocalcemia include neuromuscular irritability, tetany, and seizures, which are rapidly resolved with intravenous administration of calcium gluconate 3
- Chronic hypocalcemia often has more subtle manifestations, and its symptoms can involve almost any organ and system, ranging from asymptomatic to life-threatening conditions 4
Treatment of Hypocalcemia
- Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 4
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 4
- In hypoparathyroidism, providing the missing hormone with the use of the recombinant human (rh) PTH(1-84) has been recently approved, and this new therapy has the advantage of being effective for correcting serum calcium levels and significantly reducing the daily requirements of calcium and active vitamin D supplements 4
- Calcium supplementation can help meet requirements, and calcium from carbonate and citrate are the most common forms of calcium supplements 5
Management of Hypocalcemia
- Treatment and management options for chronic hypocalcemia vary depending on the underlying disorder 3
- Management of chronic hypocalcemia requires knowledge of the factors that influence the complex regulatory axes of calcium homeostasis in a given disorder 3
- In critically ill patients, treating severe hypocalcemia is generally recommended, whereas treating moderate or mild hypocalcemia can lead to higher mortality and organ dysfunction, outweighing the potential clinical benefits 6