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Hypocalcemia Treatment
Principles of Therapy
- Treatment will depend on the severity, cause, presence of symptoms and how rapidly the hypocalcemia developed
- Emergency which requires immediate attention
- Ca (IV) should be administered until signs and symptoms abate or until serum Ca levels rise
- 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)
- 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
- Please see the latest MIMS for specific prescribing information and the Hypomagnesemia disease management chart for further information
- 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
