Hypocalcemia Treatment

Treatment

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
Please see the latest MIMS for specific prescribing information and the Hypomagnesemia disease management chart for further information

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

HK in CKD: Do diet, HD frequency matter?

Elvira Manzano, 28 Jun 2020

Hyperkalaemia (HK) occurrence and recurrence are frequent in advanced CKD*, creating a perfect storm for cardiovascular events and death, says Professor Juan-Jesus Carrero from the Karolinska Institute, Solna, Sweden, at ERA-EDTA 2020. Given these risks, acutely elevated potassium (K+) should merit clinical attention.

Continuous glucose monitoring versus self-monitoring of blood glucose: A healthcare professional’s perspective

26 Aug 2021

Technological advancements have improved glucose monitoring and diabetes care, as well as empowered patients in self-care. The introduction of continuous glucose monitoring systems (CGM), such as the Abbott FreeStyle Libre^TM, offers patients an alternative and additional advantages to self-monitoring of blood glucose (SMBG).

Empagliflozin’s clinical endorsement: Revolutionising guidelines across specialties

08 Jun 2020

In this third issue we take a look at how empagliflozin made a bold impact on clinical guidelines across multiple specialties. We will explore how existing treatment recommendations were altered, and summarise the current guidelines and future perspectives of empagliflozin’s use.