Home Forums General Medicine Treatment of Acute Hypocalcaemia in ADULTS

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    There is no national guidance on the treatment of hypocalcaemia, and practice varies widely between hospital Trusts. The guidance in this document reflects practice at one of the teaching Hospitals in UK.

    The cause of the hypocalcaemia should be established and if possible, steps taken to correct it before calcium is administered .

    Mild, asymptomatic hypocalcaemia is usually treated with oral calcium replacement at a dose of 10 to 50 mmol calcium daily for simple deficiency states and adjusted to the patient’s individual requirements.

    In severe acute hypocalcaemia or hypocalcaemic tetany, 2.2 to 4.5 mmol calcium is administered as a slow intravenous injection over 5 to 10 minutes and is usually followed by a calcium infusion to prevent recurrence.
    Intravenous calcium administration has been associated with adverse effects including serious venous irritation, hypotension, bradycardia, cardiac arrhythmias and cardiac arrest especially if calcium is administered too quickly. Care should be taken to avoid extravasation.

    Monitor urea and electrolytes including magnesium as only transient rises in serum calcium concentrations will be seen if concurrent hypomagnesaemia is not adequately treated. Ideally check parathyroid hormone and vitamin D levels before initiating treatment for hypocalcaemia.

    This guidance is not suitable for chronic hypocalcaemia, patients with complex medical problems, or those with renal impairment.

    The dose and route of calcium to correct hypocalcaemia should be determined on an individual patient basis. There are no national guidelines for the treatment of acute hypocalcaemia, and practice varies widely across Hospital .

    G Mohan.

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