From the Guidelines
The treatment of hypocalcemia involves addressing both acute symptoms and underlying causes, with the most recent and highest quality study suggesting that for symptomatic or severe hypocalcemia, immediate intravenous calcium is recommended, typically with calcium chloride as the preferred agent due to its higher elemental calcium content compared to calcium gluconate 1. For chronic management, oral calcium supplementation is the mainstay, usually with calcium carbonate 1000-2000 mg elemental calcium daily, divided into 2-3 doses, taken with food to enhance absorption.
- Vitamin D supplementation is essential for improving calcium absorption, with options including calcitriol (0.25-1 mcg daily), ergocalciferol (50,000 IU weekly), or cholecalciferol (1000-4000 IU daily) 1.
- Magnesium deficiency should be corrected if present, as it can impair parathyroid hormone secretion and action.
- The underlying cause of hypocalcemia must be identified and treated, whether it's hypoparathyroidism, vitamin D deficiency, chronic kidney disease, or medication effects.
- Regular monitoring of serum calcium, phosphate, magnesium, and vitamin D levels is necessary to adjust therapy. Treatment goals include maintaining serum calcium in the low-normal range, preventing symptoms, and avoiding complications like nephrocalcinosis from excessive treatment. Patients should be educated about symptoms of both hypo- and hypercalcemia to ensure proper management. In cases of acute hypocalcemia, especially in trauma patients, prompt correction with calcium chloride is crucial to prevent further complications, as hypocalcemia can lead to cardiac dysrhythmias and impaired coagulation 1. Overall, the management of hypocalcemia requires a comprehensive approach that addresses the underlying cause, corrects deficiencies, and monitors for potential complications, with the choice of calcium supplement and dosing tailored to the individual patient's needs and clinical context.
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 options for hypocalcemia include:
- Calcium chloride (IV) 2 for a prompt increase in plasma calcium levels
- Calcium gluconate (IV) 3 for acute symptomatic hypocalcemia in pediatric and adult patients Key consideration: Calcium gluconate (IV) is not recommended for long-term use due to unknown safety 3
From the Research
Treatment Options for Hypocalcemia
- Intravenous calcium infusion is essential to raise calcium levels and resolve or minimize symptoms in the setting of acute hypocalcemia 4
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 4
- In hypoparathyroidism, providing the missing hormone with the use of the recombinant human (rh) PTH(1-84) has been recently approved by the Food and Drug Administration (FDA) and the European Medicines Agency (EMA) 4
Calcium Salts Used in Treatment
- Calcium gluconate is commonly used for the treatment of moderate to severe acute hypocalcemia 5, 6
- Calcium chloride can also be used, but it may cause more irritation to the vessel wall compared to gluconate salts 6
- Calcium gluceptate is another option, but its use is less common compared to calcium gluconate and calcium chloride 6
Management of Hypocalcemia
- Treatment and management options for chronic hypocalcemia vary depending on the underlying disorder 7
- 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 7
- Management of chronic hypocalcemia requires knowledge of the factors that influence the complex regulatory axes of calcium homeostasis in a given disorder 7