From the Guidelines
Hypocalcemia in rhabdomyolysis should be treated with calcium supplementation only when patients are symptomatic, as recommended by the most recent guideline evidence 1.
Treatment Approach
The treatment of hypocalcemia in rhabdomyolysis should prioritize symptom management, as asymptomatic hypocalcemia may not require treatment, according to the consensus conference on the management of tumor lysis syndrome 1.
- For symptomatic patients, calcium gluconate 50-100 mg/kg should be infused and cautiously repeated if necessary, as suggested by the consensus conference on the management of tumor lysis syndrome 1.
- However, the European guideline on management of major bleeding and coagulopathy following trauma: sixth edition, recommends the administration of calcium chloride to correct hypocalcaemia 1.
Monitoring and Management
- Aggressive intravenous fluid administration remains the cornerstone of rhabdomyolysis management, as it helps clear myoglobin and prevents acute kidney injury.
- Monitor calcium, phosphorus, and renal function closely during treatment, and address the underlying cause of rhabdomyolysis simultaneously.
Considerations
- Calcium administration must be approached carefully in rhabdomyolysis because it may worsen muscle damage and increase calcium deposition in injured muscles.
- The underlying cause of hypocalcemia in rhabdomyolysis is calcium sequestration in damaged muscles and calcium-phosphate precipitation due to hyperphosphatemia from muscle breakdown.
From the FDA Drug Label
10% Calcium Chloride Injection, USP is indicated for the treatment of hypocalcemia in those conditions requiring a prompt increase in plasma calcium levels. Calcium Gluconate Injection is indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia.
Treatment of Hypocalcemia in Rhabdomyolysis:
- Calcium chloride (IV) 2 and calcium gluconate (IV) 3 can be used to treat hypocalcemia.
- Both medications are indicated for the treatment of hypocalcemia, but the labels do not specifically mention rhabdomyolysis.
- However, since rhabdomyolysis can cause hypocalcemia, these medications can be used to treat the resulting hypocalcemia.
From the Research
Treatment of Hypocalcemia in Rhabdomyolysis
- Hypocalcemia is a common complication of rhabdomyolysis, and its treatment is crucial to prevent further complications 4, 5.
- The pathogenesis of hypocalcemia in rhabdomyolysis is thought to be related to calcium deposition in injured tissues, as documented by technetium-99 scan 5.
- The management of hypocalcemia in rhabdomyolysis includes aggressive fluid administration to restore hypovolemia and urine alkalization, as well as treatment of concomitant electrolyte and metabolic disorders 4.
- In some cases, hypercalcemia may develop during the diuretic phase of acute renal failure, and this is thought to be related to an increase in serum levels of 1,25-dihydroxyvitamin D [1,25(OH)2D] 5.
- Treatment of hypocalcemia due to hypoparathyroidism, a rare cause of rhabdomyolysis, requires careful management of serum calcium levels to prevent further muscle damage 6.
Electrolyte Disorders in Rhabdomyolysis
- Electrolyte disorders, including hyperkalemia, metabolic acidosis, hyperphosphatemia, and hypocalcemia, are common complications of rhabdomyolysis 4.
- These disorders should be treated promptly to prevent further complications, such as cardiac arrhythmias and acute renal failure 4, 7.
- Hemodialysis may be necessary in cases of life-threatening hyperkalemia and metabolic acidosis 4.