From the Guidelines
Hypocalcemia is caused by several factors including vitamin D deficiency, hypoparathyroidism, kidney disease, pancreatitis, certain medications (bisphosphonates, anticonvulsants), magnesium deficiency, and surgical removal of the parathyroid glands, and treatment should focus on addressing the underlying cause while maintaining normal serum calcium levels to prevent secondary hyperparathyroidism and renal osteodystrophy 1.
Causes of Hypocalcemia
- Vitamin D deficiency
- Hypoparathyroidism
- Kidney disease
- Pancreatitis
- Certain medications (bisphosphonates, anticonvulsants)
- Magnesium deficiency
- Surgical removal of the parathyroid glands
Treatment Options
- For severe symptomatic hypocalcemia, immediate intravenous calcium is needed, typically 1-2 grams of calcium gluconate given slowly over 10-20 minutes.
- For chronic or less severe cases, oral calcium supplements (calcium carbonate 1000-2000 mg elemental calcium daily, divided into 2-3 doses) combined with vitamin D supplementation (cholecalciferol 1000-4000 IU daily or calcitriol 0.25-1 mcg daily) is recommended 1.
- Addressing underlying causes is crucial, such as treating hypoparathyroidism with parathyroid hormone replacement (Natpara), correcting magnesium deficiency, or adjusting medications that may be causing the problem.
- Regular monitoring of calcium levels is essential during treatment, as excessive supplementation can lead to hypercalcemia, kidney stones, or other complications 1.
- Dietary changes to include calcium-rich foods like dairy products, leafy greens, and fortified foods can help maintain calcium levels long-term.
- In patients with chronic kidney disease (CKD), treatment should focus on preventing hyperphosphatemia and avoiding hypercalcemia, with a suggested dialysate calcium concentration between 1.25 and 1.50 mmol/L (2.5 and 3.0 mEq/L) for patients with CKD G5D 1.
From the FDA Drug Label
Maternal hypocalcemia can result in an increased rate of spontaneous abortion, premature and dysfunctional labor, and possibly preeclampsia Infants born to mothers with hypocalcemia can have associated fetal and neonatal hyperparathyroidism, which in turn can cause fetal and neonatal skeletal demineralization, subperiosteal bone resorption, osteitis fibrosa cystica and neonatal seizures
The causes of hypocalcemia are not directly stated in the provided drug labels. However, maternal hypocalcemia can result in several complications, including:
- Spontaneous abortion
- Premature and dysfunctional labor
- Preeclampsia Additionally, hypocalcemia in infants born to mothers with hypocalcemia can cause:
- Fetal and neonatal hyperparathyroidism
- Skeletal demineralization
- Subperiosteal bone resorption
- Osteitis fibrosa cystica
- Neonatal seizures 2
From the Research
Causes of Hypocalcemia
- Hypocalcemia can be caused by disorders that are parathyroid hormone (PTH) mediated or non-PTH mediated 3
- The most frequent cause of hypocalcemia is postsurgical hypoparathyroidism 3
- Other causes of hypocalcemia include inadequate levels of parathyroid hormone or vitamin D, or resistance to these hormones 4
- Hypocalcemia can also be caused by magnesium deficiency, as magnesium is essential for the release of parathyroid hormone and the activation of vitamin D 4, 5
Treatment Options for Hypocalcemia
- Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 3, 4
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 3, 4
- In hypoparathyroidism, providing the missing hormone with the use of recombinant human PTH(1-84) has been recently approved by the FDA and EMA 3
- Treatment can be further intensified with thiazide diuretics, phosphate binders, and a low-salt and low-phosphorus diet when treating hypocalcemia secondary to hypoparathyroidism 4
- Magnesium supplementation may also be necessary in cases of magnesium deficiency 4, 5