Emergency treatment

Acute symptomatic hypocalcemia is a medical emergency that requires intravenous calcium therapy. Initial treatment consists of the administration of a calcium bolus (100-200 mg of elemental calcium over 10 min) followed by a maintenance calcium infusion of 1 to 2 mg/kg/h. Calcium chloride (10 per cent) contains 27.2 mg Ca/ml and calcium gluconate (10 per cent) contains 9 mg Ca/ml.

Subsequent rate adjustments should be based on serial calcium measurements obtained every 2 to 4 h. Measurement of serum magnesium is important in patients with ionized hypocalcemia because hypo- and hypermagnesemic hypocalcemia respond poorly to calcium therapy and magnesium replacement may be all that is needed to correct the hypocalcemia (Reber,an.d Heath 19.9.5). Potassium deficiency protects patients from hypocalcemic tetany, and correction of hypokalemia without correction of hypocalcemia may induce tetany. Administration of drugs that may aggravate hypocalcemia (e.g. furosemide (frusemide)) should be discontinued or another drug substituted, if possible. Calcium must be administered cautiously to patients receiving digitalis, since hypercalcemia predisposes to digitalis toxicity

(Zaiog.i,,a.Dd,C.hernow 1986). Optimal therapy requires frequent monitoring of serum calcium, magnesium, phosphorus, potassium, and creatinine levels, as well as electrographic and hemodynamic status. Intravenous calcium salt is very irritating to the veins and tissue injury may result from extravasation.

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