From the Guidelines
To replace calcium in hypocalcemia orally, calcium supplements are the primary treatment option, with a recommended dosage of 1,000-2,000 mg of elemental calcium daily, divided into 2-4 doses, alongside vitamin D supplementation of 800-1,000 IU daily. The most commonly used calcium supplements are calcium carbonate (Tums, Caltrate) and calcium citrate (Citracal), with calcium carbonate containing 40% elemental calcium and calcium citrate containing 21% 1. Calcium carbonate should be taken with food to enhance absorption, while calcium citrate can be taken with or without food and may be better for patients with reduced stomach acid. Patients should also be advised to consume calcium-rich foods like dairy products, fortified plant milks, leafy greens, and canned fish with bones. Calcium supplements can interfere with certain medications, including antibiotics, bisphosphonates, and thyroid medications, so doses should be separated by at least 2-4 hours 1. Treatment effectiveness should be monitored through regular blood calcium level checks, and dosage adjustments may be necessary based on these results.
Some key considerations in treating hypocalcemia include:
- Avoiding hypercalcemia, as it can have detrimental effects on morbidity in patients with chronic kidney disease (CKD) 1
- Monitoring for signs of hypocalcemia, such as fatigue, emotional irritability, and abnormal involuntary movements, and treating promptly to prevent complications 1
- Being aware of the potential for hypocalcemia to recur, especially in patients with a history of hypocalcemia or those with certain medical conditions, such as 22q11.2 deletion syndrome 1
- Considering the use of calcium supplements in patients with CKD, as they may have decreased intestinal calcium absorption and low dietary calcium intake 1
Overall, the goal of treatment is to restore normal calcium levels and prevent complications, while also minimizing the risk of hypercalcemia and other adverse effects.
From the Research
Oral Calcium Replacement in Hypocalcemia
To replace calcium in hypocalcemia orally, the following options are available:
- Oral calcium and/or vitamin D supplementation is the most frequently used treatment for chronic hypocalcemia 2
- A liquid preparation containing calcium citrate, calcium phosphate, and vitamin D3 can be effective in preventing symptoms of hypocalcemic toxicity 3
- Calcium carbonate can be given prophylactically, but its ability to alleviate hypocalcemic toxicity is limited 3
Types of Oral Calcium Supplements
Different types of oral calcium supplements can be used, including:
- Calcium carbonate
- Calcium citrate
- Calcium phosphate
- Liquid preparations containing a combination of these calcium salts and vitamin D3
Efficacy of Oral Calcium Supplements
The efficacy of oral calcium supplements in preventing hypocalcemic toxicity and treating chronic hypocalcemia has been demonstrated in several studies: