What is the treatment for hypocalcemia (low levels of calcium)?

From the Guidelines

To treat low levels of calcium, it is essential to normalize serum levels of corrected total calcium, as chronic lower levels can cause secondary hyperparathyroidism, adverse effects on bone mineralization, and increased mortality, therefore, hypocalcemia should be treated with calcium supplementation and dietary adjustments. When treating low levels of calcium, the goal is to achieve normal serum levels of corrected total calcium, as emphasized in the K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease 1. Key considerations for treatment include:

• Increasing calcium intake through diet and supplements to prevent negative calcium balance
• Avoiding high calcium intake to prevent hypercalcemia and/or soft-tissue calcification
• Monitoring for spontaneous hypercalcemia, which can occur in patients with chronic kidney disease (CKD) Treatment may involve:
• Calcium supplements such as calcium carbonate or calcium citrate
• Vitamin D supplementation to enhance calcium absorption
• Dietary adjustments to include calcium-rich foods and fortified foods
• In severe cases, prescription medications like calcitriol or intravenous calcium gluconate may be necessary, as guided by a healthcare professional. Adequate magnesium levels are also crucial, as magnesium deficiency can impair calcium regulation, and patients should be advised to drink plenty of water and limit caffeine, alcohol, and high-sodium foods that can increase calcium excretion, as supported by the K/DOQI guidelines 1.

From the FDA Drug Label

Calcium Gluconate Injection is indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia. The treatment for low levels of calcium is Calcium Gluconate Injection, which is indicated for pediatric and adult patients for the treatment of acute symptomatic hypocalcemia 2.

• The dose should be individualized within the recommended range, depending on the severity of symptoms of hypocalcemia, the serum calcium level, and the acuity of onset of hypocalcemia.
• The recommended dosage is provided in Table 1 of the Full Prescribing Information (FPI) for dosing recommendations in mg of calcium gluconate for neonates, pediatric and adult patients 2. Key considerations:
• Measure serum calcium during intermittent infusions every 4 to 6 hours and during continuous infusion every 1 to 4 hours 2.
• Calcium Gluconate Injection is not physically compatible with fluids containing phosphate or bicarbonate 2.

From the Research

Treatment Options for Low Calcium Levels

• Conventional therapy for hypoparathyroidism consists of oral calcium and either activated vitamin D or vitamin D supplements at varying doses 3
• Calcium supplementation in hypoparathyroidism usually consists of calcium carbonate because it is 40% elemental calcium by weight, but calcium citrate (21% elemental calcium) is indicated for patients with achlorhydria and proton pump inhibitor therapy 3
• Some studies suggest that a "no calcium" treatment regimen may be effective for selected patients with hypoparathyroidism, with target range serum calcium levels achieved without breakthrough hypocalcaemia-related symptoms or significant hypercalciuria 4

Dietary Interventions

• Food-based approaches can improve calcium consumption and bioavailability, particularly in low- and middle-income countries where average intakes can be below 400 mg/day 5
• Promoting animal-source foods that are naturally high in bioavailable calcium and plant foods that can contribute to calcium intake can help improve calcium consumption 5
• Staple-food fortification with calcium and biofortification can also be cost-effective methods to increase intake with minimal behavior change required 5

Calcium Supplementation Forms

• The best calcium carbonate intake form is unknown, but studies have shown that calcium carbonate intake in different forms (fasting, with water, orange juice, or breakfast) does not result in significant differences in calcium, phosphorus, and calcium×phosphorus product serum levels 6
• Calcium citrate may have a potential beneficial effect on nephrolithiasis risk compared to calcium carbonate, with a reduction in urinary oxalate excretion and less constipation 7