Emergency treatment

a. For symptomatic hypocalcemia or when serum calcium is < 5-6 mg/dL, give 10-20 mg elemental calcium per kilogram body weight, or 1-2 mL of calcium gluconate per kilogram body weight (10% solution). This should be given no faster than 1 mL/min under constant cardiac monitoring.

b. Treat hypomagnesemia with 0.1-0.2 mL/kg of 50% magnesium sulfate (0.4-0.8 mEq/kg or 5-10 mg/kg) IV or IM, again under constant cardiac monitoring. May repeat magnesium dose q12-24h.

2. Nonemergency or maintenance therapy. Oral calcium at a dose of 50-75 mg elemental calcium per kilogram per day as calcium glubionate (23 mg/mL), calcium carbonate (100 mg/mL), or calcium gluconate (9 mg/mL). Give in 4-6 divided doses, and combine with low-phosphorus formula such as maternal breast milk or Similac PM 60/40.

3. Vitamin D. Daily supplement of oral vitamin D at a dose of 400-2000 lU/day.

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