Hypocalcemia in Emergency Medicine Treatment & Management

  • Author: Christopher B Beach, MD, FACEP, FAAEM; Chief Editor: Erik D Schraga, MD   more...
 
Updated: Mar 29, 2010
 

Prehospital Care

Standard advanced cardiac life support (ACLS) procedures should be initiated in the patient whose condition is unstable. No specific therapy, other than supportive care, is recommended.

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Emergency Department Care

Most hypocalcemic emergencies are mild and require only supportive treatment and further laboratory evaluation. On occasion, severe hypocalcemia may result in seizures, tetany, refractory hypotension, or arrhythmias that require a more aggressive approach.

  • Mild hypocalcemia (when symptoms are not life threatening)
    • Confirm ionized hypocalcemia and check other pertinent laboratory tests.
    • If the cause is not obvious, send for a PTH level.
    • Depending on the PTH level, the endocrinologist may do further laboratory workup, particularly an evaluation of vitamin D levels.
    • Oral repletion may be indicated for outpatient treatment; patients requiring intravenous (IV) repletion should be admitted. (Recommended dose of elemental calcium in healthy adults is 1-3 g/d.)
  • Severe hypocalcemia (life-threatening symptoms)
    • Supportive treatment often is required prior to directed treatment of hypocalcemia (ie, IV replacement, oxygen, monitoring). Be aware that severe hypocalcemia often is associated with other life-threatening conditions.
    • Check ionized calcium and other pertinent screening laboratory tests.
    • IV replacement is recommended in severe cases. Doses of 100-300 mg of elemental calcium (calcium gluconate – 10 mL contains 90 mg elemental calcium; calcium chloride – 10 mL contains 272 mg elemental calcium) should be given over 5-10 minutes. This dosage raises the ionized level to 0.5-1.5 mmol and should last 1-2 hours. Caution should be used when giving CaCl intravenously (see Medication).
    • Calcium infusion drips should be started at 0.5 mg/kg/h and increased to 2 mg/kg/h as needed, with an arterial line placed for frequent measurement of ionized calcium.
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Consultations

Depending on the clinical situation, multiple consultations may be necessary, including internist, endocrinologist, intensivist, surgeon, oncologist, nephrologist, dietitian, and/or toxicologist.[6]

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Contributor Information and Disclosures
Author

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.

Specialty Editor Board

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.

Francisco Talavera, PharmD, PhD  Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

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.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

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

Disclosure: Nothing to disclose.

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