From the Guidelines
Treatment of low calcium (hypocalcemia) involves calcium supplementation and addressing the underlying cause, with the goal of preventing secondary hyperparathyroidism, adverse effects on bone mineralization, and increased mortality, as emphasized in the K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease 1.
Key Considerations
- For mild cases, oral calcium supplements like calcium carbonate or calcium citrate at 1,000-2,000 mg elemental calcium daily in divided doses are recommended, along with vitamin D supplementation, typically with calcitriol (0.25-0.5 mcg daily) or ergocalciferol (50,000 IU weekly) 1.
- Regular monitoring of calcium levels is crucial to adjust dosing and prevent over-correction, which can result in iatrogenic hypercalcemia, renal calculi, and renal failure 1.
- Underlying causes such as vitamin D deficiency, hypoparathyroidism, kidney disease, or medication effects must be identified and treated, and patients should maintain adequate dietary calcium through foods like dairy products, leafy greens, and fortified foods.
- Magnesium deficiency should also be corrected if present, as it can impair calcium regulation, and treatment duration depends on whether the cause is temporary or chronic, with some conditions requiring lifelong supplementation.
Special Considerations
- In patients with chronic kidney disease (CKD), net calcium absorption is reduced, and dietary calcium intake is often low, making calcium supplementation essential to prevent negative calcium balance and secondary hyperparathyroidism 1.
- In patients with 22q11.2 deletion syndrome, hypocalcemia is common, and daily calcium and vitamin D supplementation are recommended, along with regular monitoring of calcium concentrations and correction of magnesium deficiency if present 1.
From the FDA Drug Label
1 INDICATIONS & USAGE Calcium Gluconate Injection is indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia.
The treatment for low calcium (hypocalcemia) is Calcium Gluconate Injection, which is indicated for acute symptomatic hypocalcemia in pediatric and adult patients 2.
- Key points:
- Indication: Acute symptomatic hypocalcemia
- Patient population: Pediatric and adult patients
- Limitation: Not established for long-term use 2
From the Research
Treatment of Low Calcium
The treatment of low calcium, also known as hypocalcemia, can be managed through various methods, including calcium supplementation and vitamin D therapy.
- Calcium supplementation can help meet the adequate intake of calcium, especially in individuals who do not meet the recommended daily intake 3.
- Vitamin D is also essential for bone health and is often deficient in individuals with hypocalcemia 3, 4.
Forms of Calcium Supplementation
There are various forms of calcium supplements available, including:
- Calcium carbonate: the most cost-effective form, which should be taken with a meal to ensure optimal absorption 3.
- Calcium citrate: can be taken without food and is the supplement of choice for individuals with achlorhydria or who are taking histamine-2 blockers or protein-pump inhibitors 3.
- Calcium lactate and calcium gluconate: less concentrated forms of calcium and are not practical oral supplements 3.
Management of Hypocalcemia
The management of hypocalcemia can be divided into acute and chronic treatment.
- Acute hypocalcemia can be treated with intravenous calcium infusion to raise calcium levels and resolve or minimize symptoms 4.
- Chronic hypocalcemia can be treated with oral calcium and/or vitamin D supplementation, and in some cases, recombinant human parathyroid hormone (rhPTH) may be used 4, 5.
- Alternate-day calcium dosing may be an effective treatment option for chronic hypoparathyroidism, as it can help reduce the daily requirements of calcium and active vitamin D supplements 6.
Comparison of Treatment Options
Different treatment options for hypocalcemia have been compared in various studies.
- A study found that treatment with vitamin D2 compared to calcitriol resulted in less severe hypocalcemia and no difference in renal function or morbidity from hypercalcemia 7.
- Another study found that a "no calcium" regimen may be a viable option for some patients with chronic hypoparathyroidism, as it can help reduce gastrointestinal side effects and hypercalciuria-related complications 5.