From the Guidelines
Hypocalcemia in the hospital setting should be treated based on severity, with immediate intervention for symptomatic patients, and the goal is to maintain serum calcium within the normal range (8.5-10.5 mg/dL) while addressing the underlying etiology to prevent recurrence. For severe, symptomatic hypocalcemia (tetany, seizures, QT prolongation), administer IV calcium gluconate 1-2 grams (10-20 mL of 10% solution) over 10-20 minutes, followed by a continuous infusion of 1-2 mg/kg/hr elemental calcium, as recommended by recent guidelines 1. Some key points to consider when treating hypocalcemia include:
- Monitoring calcium levels every 4-6 hours initially
- Addressing the underlying cause, such as vitamin D deficiency (treat with vitamin D3 1,000-4,000 IU daily or high-dose vitamin D2 50,000 IU weekly), hypomagnesemia (correct with IV magnesium sulfate 1-2 grams), or hypoparathyroidism (may require calcitriol 0.25-1 mcg daily)
- Using oral calcium supplements like calcium carbonate 1-2 grams elemental calcium daily in divided doses for moderate hypocalcemia
- Being aware that net calcium absorption is reduced in chronic renal failure, and dietary calcium intake is often low in patients with CKD, as noted in previous studies 1
- Considering the potential risks and benefits of calcium treatment, including the risk of hypercalcemia, which can increase the Ca-P product index in blood and pose a risk for CKD patients, as discussed in earlier guidelines 1. It is essential to individualize treatment and consider the patient's specific needs and underlying conditions when managing hypocalcemia in the hospital setting.
From the FDA Drug Label
INDICATIONS & USAGE 10% Calcium Chloride Injection, USP is indicated for the treatment of hypocalcemia in those conditions requiring a prompt increase in plasma calcium levels. The treatment for hypocalcemia (low calcium levels) in a hospital setting is calcium chloride (IV), as it is indicated for the treatment of hypocalcemia in conditions requiring a prompt increase in plasma calcium levels 2.
From the Research
Treatment of Hypocalcemia
The treatment of hypocalcemia in a hospital setting typically involves the administration of calcium supplements, particularly calcium gluconate, to restore normal calcium levels in the blood.
- The dosage of calcium gluconate varies depending on the severity of hypocalcemia, with mild cases (ionized calcium [iCa] 1-1.12 mmol/L) often treated with 1-2 g of IV calcium gluconate 3.
- For moderate to severe hypocalcemia (iCa <1 mmol/L), a dosage of 2-4 g of IV calcium gluconate may be used, although this may not always be effective 3.
- In some cases, a higher dosage of 4 g of calcium gluconate infused at a rate of 1 g/h may be necessary to achieve a serum iCa >1 mmol/L 4.
- The choice of calcium salt, such as calcium gluconate or calcium chloride, depends on the specific clinical situation and the patient's individual needs, with calcium gluconate preferred due to its lower irritation of the vessel wall and better compatibility with other nutrients in parenteral nutrition 5.
Administration and Monitoring
- Calcium gluconate is typically administered intravenously, with the infusion rate and dosage adjusted based on the patient's response and serum calcium levels 3, 6, 4.
- Monitoring of serum ionized calcium levels is crucial to ensure that the treatment is effective and to avoid overcorrection, which can lead to hypercalcemia 3, 6, 4.
- Other factors, such as magnesium deficiency, should also be addressed concomitantly with calcium supplementation 7.
Specific Clinical Situations
- In patients undergoing therapeutic plasma exchange, a higher infusion rate of calcium gluconate (1.6 g/h) may be necessary to prevent hypocalcemic reactions 6.
- In critically ill trauma patients, the treatment of moderate to severe acute hypocalcemia requires careful monitoring and adjustment of calcium supplementation to achieve optimal outcomes 3, 4.