hypocalcemia
HYPOCALCEMIA
Hypocalcemia is the occurs when serum calcium concentration is below the lower limit of normal range.
Acute hypocalcemia has neuromuscular tetany as hallmark symptom. Patients have rapid decrease in serum calcium and present with symptomatic hypocalcemia.
It is an emergency condition and requires immediate attention. Ca (IV) should be administered until signs and symptoms abate or until serum Ca levels rise.
Chronic hypocalcemia has asymptomatic mild hypocalcemia. Treatment is necessary to avoid long term complications. Oral Ca may be administered.

Principles of Therapy

  • Treatment will depend on the severity, cause, presence of symptoms and how rapidly the hypocalcemia developed
Acute Hypocalcemia
  • Emergency which requires immediate attention
  •  Ca (IV) should be administered until signs and symptoms abate or until serum Ca levels rise
Chronic Hypocalcemia
  • Treatment is necessary to avoid long term complications
  • Ca (oral) may be administered

Pharmacotherapy

Ca (PO or IV)
  • Patients who present with signs and symptoms of acute hypocalcemia need to be treated with rapid parenteral administration of Ca
  • Different salts are available for IV administration
  • Chronic, asymptomatic hypocalcemia may be treated with Ca (PO)
Magnesium (Mg) (PO or IV)
  • Administer Mg (IV) if acute hypocalcemia is associated with hypomagnesemia
  • As soon as possible administer Mg (PO) to replace body stores since Mg (IV) is excreted in the urine
  • Specific prescribing information may be found in the latest MIMS and the Hypomagnesemia Disease Management Chart
Vit D Analogs (PO or IV)
  • May be necessary in cases of Vit D deficiency or resistance, dialysis patients, hypocalcemia from subtotal parathyroidectomy
  • Analogue of Vit D to be administered will depend on underlying disorder
  • If renal 1-α-hydroxylation is impaired (eg renal failure, hypoparathyroidism, etc):
    • Administer metabolites that do not require this modification
    • Calcitriol or Dihydrotachysterol
  • If decreased intake or increased losses:
    • Administer Vit D and treat underlying disorder
  • Alfacalcidol is one of the preferred agents in chronic renal failure (CRF) because it does not require renal hydroxylation
    • May also be used in hypoparathyroidism, Vit D-resistant rickets, osteomalacia, pseudohypoparathyroidism, malabsorption of Ca
  • Calcifediol is one of the preferred agents to treat simple nutritional deficiencies
    • May also be used to treat bone diseases associated with CRF or hypocalcemia caused by chronic renal dialysis
  • Calcitriol is one of the preferred agents in CRF particularly those undergoing dialysis because it does not require renal hydroxylation
    • May also be used to treat hypocalcemia caused by hypoparathyroidism, pseudohypoparathyroidism, Vit D-dependent and independent ricket
  • Cholecalciferol is used to treat simple nutritional deficiencies
  • Dihydrotachysterol is used to treat hypocalcemic tetany due to hypoparathyroidism and to treat hypocalcemia due to hypoparathyroidism
  • Ergocalciferol is used to treat simple nutritional deficiencies, Vit D-resistant rickets, hypoparathyroidism
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