Pediatric Hypocalcemia Medication

Calcium therapy is the mainstay of treatment for hypocalcemia. Therapy with IV calcium is the most effective and rapid means of elevating serum calcium concentration. After hypocalcemia is controlled, follow-up treatment with oral therapy can be given. However, in patients with asymptomatic hypocalcemia, therapy with oral calcium alone may be sufficient.

Vitamin D, in one of its various forms, is also indicated, depending on the metabolic abnormality present. However, the use of vitamin D formulations in newborns to prevent hypocalcemia has not been effective. The most important aspect of management is resolution of the primary cause (eg, hyperphosphatemia, hypomagnesemia).

The American Academy of Pediatrics (AAP) published revisions to guidelines for adequate vitamin D intake in infants, children, and adolescents.^[3] The revised guidelines now recommend a minimum daily intake of 400 IU of vitamin D beginning in the first few days following birth and continuing through adolescence. Symptomatic hypocalcemia may occur during periods of rapid growth with increased metabolic demands, long before any physical findings or radiologic evidence of vitamin D deficiency occur.

Although not used routinely due to the suggested risk of osteosarcoma, the administration of recombinant PTH in an infant with hypocalcemia refractory to calcitriol and calcium supplementation was reported to be effective.^[4]

Class Summary

Calcium is the most abundant mineral in the human body. It is essential for blood coagulation and the development and/or function of bone, teeth, nerves, and muscles. Calcium also functions as an enzymatic cofactor and affects endocrine secretory function. Supplements are used to increase serum calcium concentrations in patients with hypocalcemia. Oral preparations are prescribed to reduce phosphate absorption from the intestine in patients with hyperphosphatemia.

Calcium chloride

Calcium gluconate 10% (100 mg/mL) IV solution contains 9.8 mg/mL (0.45 mEq/mL) elemental calcium; calcium chloride 10% (100 mg/mL) contains 27 mg/mL (1.4 mEq/mL) elemental calcium.

Calcium chloride is more irritating to the veins and may affect pH; therefore, it is typically avoided in pediatric patients.

Calcium glubionate (Calcionate)

This is an oral calcium supplement. It is available as a liquid product containing glubionate salt (1800 mg/5 mL) and elemental calcium (115 mg /5 mL).

Calcium carbonate (Oyster Cal, Caltrate, Tums, Oysco 500)

Calcium carbonate is an oral supplement. In many ways, it is the calcium supplement of choice, because it provides 40% elemental calcium. (Therefore, 1 g of calcium carbonate provides 400 mg of elemental calcium.) It is well absorbed orally and is unlikely to cause diarrhea. Calcium carbonate is available in tablet and liquid form.

Class Summary

The active forms of vitamin D regulate calcium absorption and its uses in the body. They increase calcium levels by promoting absorption of calcium in the intestines and retention of it in the kidneys.

Calcitriol (Calcijex, Rocaltrol, Vectical)

This is an active metabolic form of vitamin D (ie, 1,25-dihydroxycholecalciferol). It is especially useful in liver or renal impairment because these cause an inability to hydroxylate vitamin D to its active forms. Generally, the product is rapid-acting, but it may act slowly in neonates (36-48 h). Preterm infants may be resistant to calcitriol's actions. Calcitriol is also used to treat acute hypocalcemia.