From the Guidelines
Hypocalcemia should be treated based on its severity, with mild cases managed with oral calcium and vitamin D supplements, moderate cases requiring higher doses of calcium and calcitriol, and severe cases necessitating immediate IV calcium gluconate in a monitored setting. Hypocalcemia is classified as mild, moderate, or severe based on serum calcium levels and symptom presentation. According to the study on managing adults with 22q11.2 deletion syndrome 1, hypocalcemia can be associated with fatigue, emotional irritability, abnormal involuntary movements, seizures, and cardiac arrhythmias.
Treatment of Hypocalcemia
- Mild hypocalcemia (calcium 8.0-8.5 mg/dL) can be treated with oral calcium supplements like calcium carbonate 1000-1500 mg elemental calcium daily divided into 2-3 doses, plus vitamin D supplementation (cholecalciferol 1000-2000 IU daily) as recommended for adults with 22q11.2DS 1.
- Moderate hypocalcemia (calcium 7.0-8.0 mg/dL) may present with perioral numbness, paresthesias, and muscle cramps, requiring higher oral calcium doses of 2000-3000 mg daily plus calcitriol 0.25-0.5 mcg daily.
- Severe hypocalcemia (calcium <7.0 mg/dL) is a medical emergency that can cause tetany, seizures, QT prolongation, and cardiac arrhythmias, requiring immediate IV calcium gluconate (1-2 ampules of 10% solution over 10-20 minutes, followed by continuous infusion) in a monitored setting.
Monitoring and Prevention
Regular investigations including measurements of pH-corrected ionized calcium, magnesium, parathyroid hormone, and creatinine concentrations are recommended for adults with 22q11.2DS 1. Targeted monitoring of calcium concentrations should be considered at vulnerable times, such as peri-operatively, perinatally, or during severe illness. Magnesium supplementation is indicated for those with hypomagnesemia, as it can cause refractory hypocalcemia. Caution is advised with respect to over-correction, which can result in iatrogenic hypercalcemia, renal calculi, and renal failure.
From the Research
Definition and Classification of Hypocalcemia
- Hypocalcemia is defined as a serum calcium level less than 8 mg/dL (2.12 mmol/L) 2
- It can be classified into three categories: mild, moderate, and severe hypocalcemia
- The classification is based on the severity of symptoms and the level of serum calcium
Causes of Hypocalcemia
- Hypocalcemia can be caused by various disorders, including hypoparathyroidism, vitamin D deficiency, and resistance to parathyroid hormone or vitamin D 3, 2, 4
- Other causes of hypocalcemia include postsurgical hypoparathyroidism, magnesium deficiency, and certain medications 5, 2
Symptoms of Hypocalcemia
- Symptoms of hypocalcemia can range from asymptomatic to life-threatening conditions 2
- Mild hypocalcemia may not cause any symptoms, while moderate hypocalcemia can cause symptoms such as neuromuscular irritability, tetany, and seizures 3, 6
- Severe hypocalcemia can cause life-threatening conditions, such as cardiac arrhythmias and respiratory failure 6, 2
Treatment of Hypocalcemia
- Treatment of hypocalcemia depends on the severity of symptoms and the underlying cause 5, 3, 2
- Mild hypocalcemia can be treated with oral calcium and vitamin D supplements, while moderate to severe hypocalcemia may require intravenous calcium infusion 5, 2
- In cases of hypoparathyroidism, treatment with recombinant human parathyroid hormone (rhPTH) may be necessary 2