Management of Hypocalcaemia

In this article, we will discuss the Management of Hypocalcaemia. So, let’s get started.

Management

Treatment for hypocalcaemia depends on severity and its progression. The low serum calcium associated with hypoalbuminaemia does not require treatement. Mild hypocalcaemia needs only observation and oral supplementation of calcium and vitamin D. Severe symptomatic hypocalcaemia in the presence of tetany seizures or arthythmias, should be treated as an emergency with 10% calcium gluconate (90 mg elemental calcium in 10 ml); 2 ampoules (20 ml) infused I.V.over 10 minutes followed by infusion of 60 ml (5–6 ampoules) in 500 ml of glucose (1 mg/ml) at a rate of 0.5-2.0 mg/kg/hour. Serum calcium should be monitored every 4-6 hours and infusion rate adjusted to keep the serum calcium between 8–9 mg/dl. This is followed by oral calcium and vitamin D supplementation. Hypomagnesemia, if present, may be corrected by magnesium administration simultaneously. If tetany is not relieved by giving calcium, magnesium may be tried. Hypocalcaemia due to hyperventilation (alkalosis) can be overcome by rebreathing expired air in a paper bag or administering 5% CO2, in oxygen.

Treatment of chronic hypocalcaemia due to hypoparathyroidism, pseudohypoparathyroidism and CRF is with oral calcium (2-4 g of elemental calcium every day) and vitamin D (0.5-2 ug calcitrol/day) for life-long. Vitamin D metabolite or calcium is given prophylactically to patients receiving chronic anticonvulsant therapy. Commercial preparations of PTH for hypoparathyroidism are unsatisfactory as its administration needs frequent injections and hormone therapy becomes ineffective due to antibody formation. A check of urinary calcium execretion is recommended after the initiation of therapy because hypercalciuria (urine calcium excretion >300 mg or 7.5 mmol/day) or urine calcium-creatinine ratio greater than 0.3 may impair kidney function in these patients.

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