2. Diagnosis: Hypocalcemia

3. Condition:

4. Vital signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; R>25,

<10; T >38.5°C; or any abnormal mental status.

5. Activity: Up ad lib

7. Diet: No added salt diet.

8. Special Medications:

Symptomatic Hypocalcemia:

-Calcium chloride, 10% (270 mg calcium/10 mL vial) give 5-10 mL slowly over 10 min or dilute in 50-100 mL of D5W and infuse over 20 min, repeat q20-30 min if symptomatic, or hourly if asymptomatic. Correct hyperphosphatemia before hypocalcemia OR

-Calcium gluconate, 20 mL of 10% solution IV (2 vials)(90 mg elemental calcium/10 mL vial) infused over 10-15 min, followed by infusion of 60 mL of calcium gluconate in 500 cc of D5W (1 mg/mL) at 0.5-2.0 mg/kg/h.

Chronic Hypocalcemia:

-Calcium carbonate with vitamin D (Oscal-D) 1-2 tab PO tid OR

-Calcium carbonate (Oscal) 1-2 tab PO tid OR

-Calcium citrate (Citracal) 1 tab PO q8h or Extra strength Tums 1-2 PO with meals.

-Vitamin D2 (Ergocalciferol) 1 tab PO qd.

-Calcitriol (Rocaltrol) 0.25 mcg PO qd, titrate up to 0.5-2.0 mcg qid.

-Docusate sodium (Colace) 1 tab PO bid.

10. Labs: SMA 7&12, phosphate, Mg. 24h urine calcium, potassium, phosphate, magnesium.

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