eMedicine Specialties > Emergency Medicine > Endocrine & Metabolic

Hypoparathyroidism: Treatment & Medication

Author: David J Wallace, MD, MPH, Critical Care Medicine Fellow, University of Pittsburgh Medical Center
Coauthor(s): Agnieszka Gliwa, MD, Assistant Professor of Medicine, State University of New York Downstate Medical Center College of Medicine, Brooklyn; Attending Physician and Endocrinologist, Staten Island University Hospital
Contributor Information and Disclosures

Updated: Apr 15, 2009

Treatment

Prehospital Care

  • Address and stabilize ABCs.
  • Obtain intravenous access.
  • Control seizures with benzodiazepines.

Emergency Department Care

Acute, symptomatic hypocalcemia is a medical emergency. The main goal of treatment is to restore serum calcium levels to alleviate symptoms of acute hypocalcemia. In the setting of severe symptoms, calcium therapy should be given even if serum levels are only mildly reduced.

Care to prevent long-term complications from hypocalcemia or hypercalcemia42 should be coordinated with an endocrinologist.

  • Intravenous calcium: 100-300 mg elemental calcium diluted in 150 mL D5W over 10 minutes (10-30 mL of 10% calcium gluconate [9.3 mg/mL elemental calcium])
    • This solution raises ionized calcium level by 0.5-1.5 mmol. Calcium chloride may be used if infused through a central line, as it can be harmful when given in a peripheral vein.
    • Initial rate of infusion is 0.3-2 mg elemental calcium/kg/h. This scale is not exact; base subsequent adjustments on serial calcium measurements every 2-4 hours.
    • Infuse children with 2 mg/kg elemental calcium, or about 0.2 mL of 10% calcium gluconate/kg, IV.
  • Oral therapy: Calcium carbonate, 1-2 grams or more per day, in 3-4 divided doses.
    • May be appropriate for patients with mildly lowered calcium levels and mild or no symptoms.

Consultations

Consult an endocrinologist.

Medication

Hypoparathyroidism is treated primarily with vitamin D. Dietary supplementation with Ca2+ may be necessary.

Electrolyte supplements

Hypoparathyroidism manifests as hypocalcemia. As a result, calcium supplementation may be indicated.


Calcium gluconate (Kalcinate)

Can be given IV initially, then maintained as high-calcium diet. Some patients require calcium supplementation. The 10% IV solution provides 100 mg/mL of calcium gluconate that equals 9 mg/mL (0.46 mEq/mL) of elemental calcium. One 10-mL ampule contains 93 mg of elemental calcium.

Adult

100-300 mg elemental calcium IV (10-30 mL of 10% calcium gluconate) diluted in 150 mL D5W over 10 min; initial rate of infusion is 0.3-2 mg of elemental calcium/kg/h

Pediatric

2 mg/kg IV of elemental calcium (about 20 mg/kg of calcium gluconate 10%)

May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; when administered IV, antagonizes effects of calcium channel blockers; large intake of dietary fiber may decrease absorption and levels

Renal calculi; hypercalcemia; hypophosphatemia; renal or cardiac disease; digitalis toxicity

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

Precautions

Caution when administering to digitalized patients or to those with respiratory failure or acidosis or severe hyperphosphatemia; closely monitor IV calcium supplementation because it can cause cardiac dysrhythmias

Vitamin D Analog

Vitamin D enhances absorption of calcium and maintains calcium homeostasis.


Calcitriol (Calcijex, Rocaltrol)

Stimulates absorption of calcium and phosphate from small intestine and promotes release of calcium from bone into blood.

Adult

0.2-2 mg PO qd, in divided doses

Pediatric

0.04-0.08 mg/kg PO qd, in divided doses

Colestipol, mineral oil, and cholestyramine may decrease absorption from small intestine; thiazide diuretics may increase effects of vitamin D; corticosteroids may decrease the effectiveness of vitamin D analogs; vitamin D requirements are increased by phenytoin and other hydantoin anticonvulsants, sucralfate, barbiturates, and primidone; concurrent use of magnesium-containing antacids may lead to hypermagnesemia

Documented hypersensitivity; hypercalcemia or malabsorption syndrome; patients receiving digitalis glycosides

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Caution in impaired renal function, renal stones, heart disease, or arteriosclerosis

More on Hypoparathyroidism

Overview: Hypoparathyroidism
Differential Diagnoses & Workup: Hypoparathyroidism
Treatment & Medication: Hypoparathyroidism
Follow-up: Hypoparathyroidism
References
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Further Reading

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Keywords

hypoparathyroidism, parathyroid hormone, PTH, hypocalcemia, hypomagnesemia, pseudohypoparathyroidism, parathyroid glands, parathyroid aplasia, DiGeorge syndrome, congenital hypoparathyroidism, parathyroid adenoma, sarcoidosis, Wilson disease, hemochromatosis, metastatic carcinoma, hypermagnesemia, autoimmune polyglandular syndrome type 1, Kenny syndrome, drug-induced hypoparathyroidism, suppression of parathyroid gland, Sanjat-Sakati syndrome, HDR syndrome, Kenny-Caffey syndrome, Pearson's marrow-pancreas syndrome, Pearson marrow-pancreas syndrome

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Contributor Information and Disclosures

Author

David J Wallace, MD, MPH, Critical Care Medicine Fellow, University of Pittsburgh Medical Center
David J Wallace, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American College of Emergency Physicians, American Medical Association, Emergency Medicine Residents Association, Society for Academic Emergency Medicine, and Society of Critical Care Medicine
Disclosure: Nothing to disclose.

Coauthor(s)

Agnieszka Gliwa, MD, Assistant Professor of Medicine, State University of New York Downstate Medical Center College of Medicine, Brooklyn; Attending Physician and Endocrinologist, Staten Island University Hospital
Agnieszka Gliwa, MD is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Medical Association, and Endocrine Society
Disclosure: Nothing to disclose.

Medical Editor

Erik D Schraga, MD, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Howard A Bessen, MD, Professor of Medicine, Department of Emergency Medicine, UCLA School of Medicine; Program Director, Harbor-UCLA Medical Center
Howard A Bessen, MD is a member of the following medical societies: American College of Emergency Physicians
Disclosure: Nothing to disclose.

CME Editor

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, Consulting Staff, Department of Emergency Medicine, Mills-Peninsula Emergency Medical Associates; Consulting Staff, Permanente Medical Group, Kaiser Permanente, Santa Clara Medical Center
Disclosure: Nothing to disclose.

 
 
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