IV: intravenous; D5W: 5% dextrose; NS: normal saline.
* Ionized calcium remains the gold standard for assessing calcium status, particularly if the diagnosis of hypocalcemia is in doubt due to hypoalbuminemia, atypical or absent symptoms, or a minimally reduced serum calcium concentration. If a laboratory known to measure ionized calcium reliably is not available, the total calcium should be corrected for any abnormalities in serum albumin, using a calcium correction formula.
¶ In patients with milder degrees of hypocalcemia or chronic hypocalcemia (due to hypoparathyroidism) who become unable to take or absorb oral supplements, as may occur after complex surgical procedures requiring prolonged recuperation, IV calcium may be needed to prevent acute hypocalcemia.
Δ Initially, IV calcium (1 or 2 g of calcium gluconate, equivalent to 90 or 180 mg elemental calcium, in 50 mL of D5W or NS) can be infused over 10 to 20 minutes. May repeat after 10 to 60 minutes if needed to resolve symptoms. Equivalent dose, SI units: 2.25 to 4.5 mmol calcium in 50 mL D5W or NS infused over 10 to 20 minutes.
Refer to UpToDate content on treatment of hypocalcemia.
◊ Patients receiving digoxin should be monitored closely for acute digitalis toxicity, which can develop with calcium infusion.
§ Initially, 1 to 4 g of elemental calcium given as calcium carbonate or calcium citrate daily, in divided doses. Refer to UpToDate content on treatment of hypocalcemia.
¥ In addition to calcium, patients with vitamin D deficiency or hypoparathyroidism require vitamin D supplementation, which often permits a lower dose of calcium supplementation. Refer to UpToDate content on hypoparathyroidism and vitamin D deficiency.
‡ In patients with hypoparathyroidism, monitoring of urinary and serum calcium and serum phosphate is required weekly initially, until a stable serum calcium concentration (at the low end of the normal range) is reached. Thereafter, monitoring at 3- to 6-month intervals is sufficient. Refer to UpToDate content on hypoparathyroidism.Do you want to add Medilib to your home screen?