Internal Medicine

0521779407-09 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:13

Hypocalcemia 779

■Assess integrity of airway

■Parenteral Ca salts for severe or life-threatening symptoms

➣Ca gluconate (90 mg Ca/10 ml)

➣Infuse 2 ampules over 10 to 20 minutes

➣IV Ca infusion: 60 ml in 500 ml D5W (1 mg/ml) – infuse at 0.5–2.0

mg/kg/hr to control symptoms

➣Measure serum total and ionized Ca every 4–6 hours

➣Maintain serum Ca 8–9 mg/dl or ionized Ca approximately

1.0 mM

➣Begin oral Ca supplements and vitamin D as soon as feasible

■If Mg – depleted, replete with Mg salts first

General Measures

■Treat symptoms, not number

■Maintain serum Ca 8.5–9 mg/dl

■Maintain urine Ca≤300 mg/24 hours

specific therapy

■Oral Ca supplements

■Add vitamin D metabolites depending on severity and titrate:

➣Ergocalciferol either daily or several times weekly

➣Calcitriol

■Thiazide diuretics as adjunctive therapy to increase Ca reabsorption

■For ADH, only treat if clinical symptoms

follow-up

■Monitor symptoms

■Monitor serum Ca frequently during initial titration

■Monitor serum and urine Ca and renal function every 6 months when

stable

■In vitamin D deficiency – monitor 25-OH D and PTH levels

■Annual eye exam for cataracts

■Consider abdominal x-ray for nephrocalcinosis in chronic therapy

■Assess bone density if needed

complications and prognosis

■General: hypercalcemia, vitamin D toxicity, renal failure (usually

reversible)

■In chronic therapy: cataracts, nephrocalcinosis, and renal stones

■Hypoparathyroidism: lifelong treatment usually indicated

■Vitamin D deficiency: curable but may require lifelong treatment