From the Guidelines
To correct a serum total corrected calcium level of 7.7 mg/dL, I recommend administering calcium chloride, with a dose of 270 mg of elemental calcium (10 mL of a 10% solution) as the preferred agent. This is based on the recent guideline from 2023, which emphasizes the importance of correcting hypocalcaemia promptly, especially in patients with critical bleeding requiring massive transfusion 1. The normal range of ionised calcium is 1.1–1.3 mmol/L, and levels below 0.9 mmol/L or serum total corrected calcium levels of 7.5 mg/dL or lower should be corrected promptly.
Some key points to consider when correcting hypocalcaemia include:
- Calcium chloride is the preferred agent due to its higher elemental calcium content (270 mg per 10 mL of a 10% solution) compared to calcium gluconate (90 mg per 10 mL of a 10% solution) 1.
- Calcium chloride may also be preferable in the setting of abnormal liver function, where decreased citrate metabolism results in the slower release of ionised calcium 1.
- Ionised calcium levels are easily monitored as part of a blood gas analysis, and correction of hypocalcaemia is crucial to prevent cardiac dysrhythmias and support coagulation cascade 1.
It is essential to note that while an association between admission ionised hypocalcaemia and mortality, increased blood transfusion, and coagulopathy has been identified, no data demonstrate that the prevention or treatment of ionised hypocalcaemia reduces mortality in patients with critical bleeding requiring massive transfusion 1.
From the Research
Calcium Replacement
- The amount of calcium to replace in cases of hypocalcemia is not explicitly stated in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that treatment of hypocalcemia often involves oral calcium and vitamin D supplementation, with the goal of maintaining serum calcium levels within a normal range 2, 3, 4.
- In cases of acute hypocalcemia, intravenous calcium infusion may be necessary to rapidly raise calcium levels and resolve symptoms 3, 4.
- The optimal dose and duration of calcium replacement therapy may vary depending on the underlying cause of hypocalcemia and individual patient factors, such as the presence of kidney disease or other comorbidities 2, 3, 4.
Factors Influencing Calcium Replacement
- Vitamin D insufficiency may contribute to hypocalcemia, particularly in patients receiving high-dose glucocorticoid therapy 5.
- Other factors that may influence calcium replacement include the presence of hypomagnesemia, hypercalciuria, and secondary hyperparathyroidism 3, 4, 5.
- Lifestyle modifications, such as increased physical activity, sun exposure, and dietary education, may also be important for maintaining adequate calcium and vitamin D levels 6.