From the Guidelines
To manage low calcium, it is essential to increase dietary calcium intake and consider supplements, while also addressing underlying conditions that may be contributing to the deficiency, as indicated by recent studies 1.
Key Recommendations
- Increase dietary calcium intake by consuming dairy products, fortified plant milks, leafy greens, and calcium-rich foods like sardines and tofu, aiming for 1,000-1,200 mg of calcium daily.
- Consider calcium supplements, typically calcium carbonate (600 mg elemental calcium per 1,500 mg tablet, taken with food) or calcium citrate (200 mg elemental calcium per 1,000 mg tablet, which can be taken without food), if diet alone is insufficient.
- Ensure adequate vitamin D levels through sunlight exposure or supplements (800-1,000 IU daily) to facilitate calcium absorption.
- Avoid excessive caffeine, alcohol, and sodium, which can deplete calcium.
- Regular weight-bearing exercise helps maintain bone density.
Underlying Conditions
- Hypoparathyroidism, vitamin D deficiency, or kidney disease may require specific treatment beyond supplementation, as suggested by studies 1.
- Medical evaluation is crucial for persistent low calcium (hypocalcemia) to identify and manage underlying conditions.
Special Considerations
- In patients with chronic kidney disease (CKD), treatment should focus on preventing hyperphosphatemia and avoiding hypercalcemia, as recommended by recent guidelines 1.
- For adults with 22q11.2 deletion syndrome, daily calcium and vitamin D supplementation are recommended, along with regular monitoring of calcium concentrations and targeted treatment for hypocalcemia, as advised by practical guidelines 1.
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. The pediatric dosage in hypocalcemic disorders ranges from 2.7 to 5.0 mg/kg hydrated calcium chloride (or 0. 136 to 0.252 mEq elemental calcium per kg, or 0.027 to 0.05 mL of 10% Calcium Chloride Injection per kg). Ionized calcium concentrations should be measured, to assist in dosage adjustment
To manage low calcium (hypocalcemia), administer calcium chloride (IV) as follows:
- Adults: 200 mg to 1 g (2-10 mL) at intervals of 1 to 3 days, depending on patient response and/or serum ionized calcium levels 2.
- Pediatrics: 2.7 to 5.0 mg/kg hydrated calcium chloride (or 0.136 to 0.252 mEq elemental calcium per kg, or 0.027 to 0.05 mL of 10% Calcium Chloride Injection per kg) 2. Key points:
- Monitor ionized calcium concentrations to adjust dosage 2.
- Administer calcium chloride (IV) slowly, preferably in a central or deep vein, at a rate not to exceed 1 mL/min 2.
From the Research
Managing Low Calcium Levels
To manage low calcium levels, it is essential to understand the underlying causes and symptoms. Low serum calcium, also known as hypocalcemia, can be life-threatening if severe 3. The symptoms of acute hypocalcemia include neuromuscular irritability, tetany, and seizures, which can be rapidly resolved with intravenous administration of calcium gluconate 3.
Treatment and Management Options
Treatment and management options for chronic hypocalcemia vary depending on the underlying disorder. Some key points to consider include:
- In patients with hypoparathyroidism, calcium and vitamin D supplementation must be carefully titrated to avoid symptoms of hypocalcemia while keeping serum calcium in the low-normal range to minimize hypercalciuria, which can lead to renal dysfunction 3.
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 4.
- Providing the missing hormone with the use of recombinant human parathyroid hormone (rhPTH) has been recently approved for the treatment of hypoparathyroidism 4.
- Calcium supplementation can help meet the daily requirements for calcium, and calcium from carbonate and citrate are the most common forms of calcium supplements 5.
Dietary Recommendations
Dietary recommendations for managing low calcium levels include:
- Increasing calcium intake through calcium-rich foods such as dairy products 6.
- Ensuring adequate vitamin D intake, as it is essential for optimal calcium absorption 6.
- Considering calcium-fortified foods and calcium supplements as alternative means of reaching optimal calcium intake 6.
- Being aware of the potential risks associated with increased calcium intake, such as gastrointestinal complaints and renal calculi 5, 6.
Supplementations as Complementary Therapy
Some studies suggest that calcium, magnesium, and vitamin D supplementations can be used as complementary therapies for hypertensive patients, with potential benefits including: