From the Guidelines
Hypocalcemia management involves prompt correction of serum calcium levels to prevent cardiac and neuromuscular complications. The approach typically consists of:
- Initial treatment with intravenous administration of calcium chloride [ 1 ], which is preferred over calcium gluconate due to its higher elemental calcium content and suitability in cases of abnormal liver function.
- A recommended dose of 10 mL of 10% calcium chloride [ 1 ], containing 270 mg of elemental calcium, may be administered.
- Oral supplementation with calcium carbonate or calcium citrate [ 2 ], 1-2 grams per day, and vitamin D [ 2 ], 1,000-2,000 IU per day, may also be initiated to maintain long-term calcium homeostasis.
- In severe cases, magnesium supplementation [ 2 ] may also be necessary to facilitate calcium absorption.
- Regular investigations, including measurements of pH-corrected ionized calcium, magnesium, parathyroid hormone, and creatinine concentrations [ 2 ], are recommended to monitor and adjust treatment as needed.
- Targeted monitoring of calcium concentrations [ 2 ] should be considered at vulnerable times, such as peri-operatively, perinatally, or during severe illness, to prevent hypocalcemia and its complications.
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. Ionized calcium concentrations should be measured, to assist in dosage adjustment
The approach to managing hypocalcemia involves:
- Administering calcium chloride (IV) at a dosage of 200 mg to 1 g (2-10 mL) at intervals of 1 to 3 days
- Measuring ionized calcium concentrations to assist in dosage adjustment
- Considering repeat injections as needed due to rapid excretion of calcium 3, 4
From the Research
Approach to Managing Hypocalcemia
The approach to managing hypocalcemia involves several key steps, including:
- Identifying the underlying cause of hypocalcemia, such as hypoparathyroidism, vitamin D deficiency, or excessive phosphate intake 5, 6, 7
- Assessing the severity of hypocalcemia, including symptoms such as neuromuscular irritability, tetany, and seizures 5, 6, 8
- Providing calcium replacement therapy, which may include intravenous calcium gluconate or calcium chloride for acute hypocalcemia, and oral calcium and/or vitamin D supplementation for chronic hypocalcemia 5, 6, 7, 8
- Monitoring serum calcium levels and adjusting treatment as needed to achieve normocalcemia 6, 7, 8
Treatment Options
Treatment options for hypocalcemia include:
- Intravenous calcium gluconate or calcium chloride for acute hypocalcemia, with a typical dose of 10-20 mL of 10% calcium gluconate in 50-100 mL of 5% dextrose i.v. over 10 minutes, followed by a calcium gluconate infusion as needed 8
- Oral calcium and/or vitamin D supplementation for chronic hypocalcemia, with a typical dose of 40-80 mg/kg/d of elemental calcium 6
- Recombinant human parathyroid hormone (rhPTH) for hypoparathyroidism, which has been shown to be effective in correcting serum calcium levels and reducing the need for calcium and vitamin D supplements 7
Special Considerations
Special considerations in the management of hypocalcemia include:
- The need for careful monitoring of serum calcium levels and adjustment of treatment as needed to avoid hypercalciuria and renal dysfunction 5
- The importance of identifying and treating underlying causes of hypocalcemia, such as vitamin D deficiency or excessive phosphate intake 5, 6, 7
- The potential for hypocalcemia to be asymptomatic, particularly in newborns and infants, and the need for screening and monitoring in high-risk populations 6