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Hypocalcemia Medication

  • Author: Manish Suneja, MD; Chief Editor: Vecihi Batuman, MD, FACP, FASN  more...
 
Updated: Jul 26, 2016
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and to prevent complications. Patients with hypocalcemia due to resistance to parathyroid hormone (PTH) generally will require long-term therapy with vitamin D and calcium supplementation. Patients with hypocalcemia associated with chronic renal failure often require phosphate binders and vitamin D supplementation.

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Calcium

Class Summary

Intravenous calcium chloride or gluconate infusions restore serum calcium levels. Calcium chloride delivers 3 times more elemental calcium than calcium gluconate.

Calcium chloride

 

Calcium chloride moderates nerve and muscle performance by regulating the action potential excitation threshold. This form of calcium is preferred for patients in cardiac arrest and in other serious cases.. The 10% IV solution provides 100 mg/mL of calcium chloride equaling 27.2 mg/mL (1.4 mEq/mL) of elemental calcium (ie, 10 mL of calcium chloride 10% solution contains 272 mg of elemental calcium).

Calcium gluconate (Cal-GLU)

 

Calcium gluconate moderates nerve and muscle performance and facilitates normal cardiac function. It is the preferred form of calcium for patients not in cardiac arrest. One ampule contains 93 mg of elemental calcium. After IV treatment, calcium levels can usually be maintained with a high-calcium diet, although some patients also require oral calcium supplementation.

The oral formulation is usually used as supplementation to IV calcium therapy. Amounts of elemental calcium in calcium gluconate are as follows:

• 500-mg tablet: 45 mg

• 650-mg tablet: 58.5 mg

• 975-mg tablet: 87.75 mg

• 1-g tablet: 90 mg

Calcium carbonate (Oystercal, Caltrate, Oysco 500, Tums E-X, Children's Pepto)

 

Calcium carbonate is indicated to restore and maintain normocalcemia when hypocalcemia is not severe enough to warrant rapid replacement. It is used orally as supplementation to IV calcium therapy. Calcium carbonate moderates nerve and muscle performance by regulating the action potential excitation threshold. Amounts of elemental calcium in calcium carbonate tablets are as follows: Tums, 200 mg; Rolaids, 220 mg; Os-Cal, 500 mg

Calcium citrate (Calcitrate, Cal-Citrate 225, Cal-Cee)

 

Calcium citrate is an oral formulation usually used as supplementation to IV calcium therapy. Calcium moderates nerve and muscle performance by regulating the action potential excitation threshold and facilitating normal cardiac function. Give the amount needed to supplement dietary intake, so as to reach recommended daily amounts. The amount of elemental calcium in 1000 mg of calcium citrate is 210 mg.

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Vitamin D

Class Summary

Vitamin D restores calcium levels in conditions associated with vitamin D deficiency. Vitamin D helps control hyperparathyroidism in patients with chronic renal failure and end-stage renal disease.

Calcitriol (Calcijex, Rocaltrol, Vectical)

 

Calcitriol increases calcium levels by promoting calcium absorption in the intestines and calcium retention in the kidneys. To prevent hyperparathyroidism, patients on dialysis may require higher doses, such as 1-2 mcg/day IV administered 2-3 times per week (approximately every other day).

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Parathyroid Hormone Analogs

Class Summary

Recombinant human parathyroid hormone may be required in addition to calcium and vitamin D supplementation for hypocalcemia.

Human parathyroid hormone, recombinant (Natpara, rhPTH)

 

Parathyroid hormone raises serum calcium by increasing renal tubular calcium reabsorption, increasing intestinal calcium absorption, and increasing bone turnover. rhPTH is indicated as an adjunct to calcium and vitamin D to control hypocalcemia in patients with hypoparathyroidism.

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Contributor Information and Disclosures
Author

Manish Suneja, MD Associate Professor, Department of Internal Medicine, Division of Nephrology, University of Iowa Hospitals and Clinics

Manish Suneja, MD is a member of the following medical societies: American College of Physicians, American Society of Nephrology, National Kidney Foundation

Disclosure: Nothing to disclose.

Coauthor(s)

Heather A Muster, MD, MS Medical Director, Davita Clinical Research

Heather A Muster, MD, MS is a member of the following medical societies: American College of Physicians, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Minnesota Medical Association, National Kidney Foundation

Disclosure: Nothing to disclose.

Specialty Editor Board

Eleanor Lederer, MD, FASN Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD, FASN is a member of the following medical societies: American Association for the Advancement of Science, International Society of Nephrology, American Society for Biochemistry and Molecular Biology, American Federation for Medical Research, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, Kentucky Medical Association, National Kidney Foundation, Phi Beta Kappa

Disclosure: Received grant/research funds from Dept of Veterans Affairs for research; Received salary from American Society of Nephrology for asn council position; Received salary from University of Louisville for employment; Received salary from University of Louisville Physicians for employment; Received contract payment from American Physician Institute for Advanced Professional Studies, LLC for independent contractor; Received contract payment from Healthcare Quality Strategies, Inc for independent cont.

Chief Editor

Vecihi Batuman, MD, FACP, FASN Huberwald Professor of Medicine, Section of Nephrology-Hypertension, Tulane University School of Medicine; Chief, Renal Section, Southeast Louisiana Veterans Health Care System

Vecihi Batuman, MD, FACP, FASN is a member of the following medical societies: American College of Physicians, American Society of Hypertension, American Society of Nephrology, International Society of Nephrology

Disclosure: Nothing to disclose.

Acknowledgements

Jeffrey L Arnold, MD, FACEP Chairman, Department of Emergency Medicine, Santa Clara Valley Medical Center

Jeffrey L Arnold, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Physicians

Disclosure: Nothing to disclose.

Christopher B Beach, MD, FACEP, FAAEM Associate Professor and Vice Chair of Emergency Medicine, Department of Emergency Medicine, Associate Professor of Institute for Healthcare Studies, Institute for Patient Safety, Feinberg School of Medicine, Northwestern University

Christopher B Beach, MD, FACEP, FAAEM is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Robin R Hemphill, MD, MPH Associate Professor, Director, Quality and Safety, Department of Emergency Medicine, Emory University

Robin R Hemphill, MD, MPH is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Eleanor Lederer, MD Professor of Medicine, Chief, Nephrology Division, Director, Nephrology Training Program, Director, Metabolic Stone Clinic, Kidney Disease Program, University of Louisville School of Medicine; Consulting Staff, Louisville Veterans Affairs Hospital

Eleanor Lederer, MD is a member of the following medical societies: American Association for the Advancement of Science, American Federation for Medical Research, American Society for Biochemistry and Molecular Biology, American Society for Bone and Mineral Research, American Society of Nephrology, American Society of Transplantation, International Society of Nephrology, Kentucky Medical Association, National Kidney Foundation, and Phi Beta Kappa

Disclosure: Dept of Veterans Affairs Grant/research funds Research

James W Lohr, MD Professor, Department of Internal Medicine, Division of Nephrology, Fellowship Program Director, University of Buffalo State University of New York School of Medicine and Biomedical Sciences

James W Lohr, MD is a member of the following medical societies: American College of Physicians, American Heart Association, American Society of Nephrology, and Central Society for Clinical Research

Disclosure: Genzyme Honoraria Speaking and teaching

Alfredo A Pegoraro, MD Consulting Staff, Nephrology Associates

Alfredo A Pegoraro, MD is a member of the following medical societies: American Medical Assocation, American Society of Nephrology, and International Society of Nephrology

Disclosure: Nothing to disclose.

Erik D Schraga, MD Staff Physician, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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Electrocardiogram (ECG) findings in severe hypocalcemia.
 
 
 
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