Hypocalcemia medical therapy: Difference between revisions
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* Until the patient receives oral calcium and vitamin D, IV calcium should be continued. | * Until the patient receives oral calcium and vitamin D, IV calcium should be continued. | ||
==== Mild or Chronic hypocalcemia ==== | |||
* When serum corrected calcium levels are between 7.5 to 8.0 mg/dL are considered as mild hypocalcemia. | |||
* Oral calcium supplementation is preferred for the patients who are presenting with mild or chronic hypokalemia. | |||
* | |||
===Contraindicated medications=== | ===Contraindicated medications=== | ||
Revision as of 19:28, 10 July 2018
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Vamsikrishna Gunnam M.B.B.S [2]
Overview
Cause, severity and the presence of symptoms decide the treatment of hypocalcemia. In mild to moderate cases hypocalcemia can be treated by giving oral calcium and vitamin D supplements but in severe cases intravenous (IV) calcium gluconate is preferred. Most of the hypocalcemic cases are mild and require only supportive treatment and laboratory evaluation.
Medical Therapy
- Pharmacologic medical therapies for hypocalcemia include calcium, vitamin D , calcium gluconate[1][2]
- Patients who are presenting with asymptomatic hypocalcemia symptoms it is important to repeat the levels of ionized calcium and confirm it.
THERAPEUTIC APPROACH
- Patients who are presenting with hypocalcemia we recommend intravenous (IV) calcium especially who are showing the following features[3]
- Patients who have prolonged QT interval.
- Patients who are having serum corrected calcium to ≤7.5 mg/dL.
- Patients who are positive for clinical symptoms like carpopedal spasm, tetany, seizures.
- Patients who are presenting with milder symptoms of neuromuscular irritability like paresthesias and corrected calcium levels more than 7.5 mg/dL treating with oral calcium and vitamin D supplements is of first choice.
- Patients with milder hypocalcemia who are on the oral supplements and shows no sign of improvement the next best best step in treating would be switching to IV calcium.
- And patients who are requiring intravenous (IV) repletion should be admitted.
- Preferred regimen (1): Elemental calcium 1-3 g/d.
Severe Hypocalcemia
- IV calcium is recommended for patients who shows symptoms of severe hypocalcemia like the following
- Carpopedal spasm
- Tetany
- Seizures
- QT interval prolongation
- IV calcium is recommended for asymptomatic patients whose serum corrected calcium levels are ≤7.5 mg/dL.
- If left untreated asymptomatic patients may end up with serious complications.
- Following post-radical neck dissection patients may end up with acute hypoparathyroidism which leads to acute hypocalcemia due to rapid reduction in serum calcium
- Preferred regimen (1): IV calcium gluconate 1 or 2 g in 50 mL of 5 percent dextrose or normal saline given over 10 to 20 minutes.
- Due to risk of serious cardiac dysfunction, calcium should be given slowly.
- Following should be considered while preparing the IV calcium infusion
- Calcium should be diluted in dextrose or water because concentrated calcium is an irritant to veins.
- IV infusion should not contain bicarbonate or phosphate.
- Until the patient receives oral calcium and vitamin D, IV calcium should be continued.
Mild or Chronic hypocalcemia
- When serum corrected calcium levels are between 7.5 to 8.0 mg/dL are considered as mild hypocalcemia.
- Oral calcium supplementation is preferred for the patients who are presenting with mild or chronic hypokalemia.
Contraindicated medications
Hypocalcemia is considered an absolute contraindication to the use of the following medications:
References
- ↑ Cooper MS, Gittoes NJ (June 2008). "Diagnosis and management of hypocalcaemia". BMJ. 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.BE. PMC 2413335. PMID 18535072.
- ↑ Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.
- ↑ Carroll R, Matfin G (February 2010). "Endocrine and metabolic emergencies: hypocalcaemia". Ther Adv Endocrinol Metab. 1 (1): 29–33. doi:10.1177/2042018810366494. PMC 3474611. PMID 23148147.