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Pediatric Hypoparathyroidism Medication

  • Author: Pisit (Duke) Pitukcheewanont, MD; Chief Editor: Stephen Kemp, MD, PhD  more...
Updated: Aug 05, 2015

Medication Summary

Calcium and calcitriol (active vitamin D) are the mainstays of treatment for hypoparathyroidism and pseudohypoparathyroidism (PHP). To relieve immediate severe symptoms of hypocalcemia, an intravenous bolus of 9-15 mg elemental calcium/kg (1 g calcium gluconate = 90 mg elemental calcium = 4.5 mEq elemental calcium) is administered over 10-30 min. Then, either intermittent boluses or a continuous IV infusion is initiated (60 mg elemental calcium/kg/d). Oral calcium is initiated for a total of 100 mg elemental calcium/kg/d divided 4 times daily. Once serum calcium concentrations range from 8-9 mg/dL, the calcium dose is weaned to the minimum dose necessary to maintain a low-normal serum calcium concentration.

In some studies, synthetic human PTH 1-34, both once and twice daily, has been shown to effectively treat children with hypoparathyroidism. However, this therapy is not yet approved for the treatment of hypoparathyroidism.[6]


Calcium supplements

Class Summary

Numerous calcium preparations are available. An intravenous dose quickly but transiently corrects the serum calcium concentration and relieves hypocalcemic symptoms. Severe hypocalcemia can be treated with a continuous calcium infusion; a transition to the oral form can be made when the serum calcium concentration is within a safe range. Tailoring of calcium dosing to each patient's needs is essential. In fact, once adequate amounts of active vitamin D are present, some patients can absorb all the calcium they need through the diet and oral calcium preparations can be discontinued. Intravenous calcium gluconate is preferred in children. For enteral preparation in young children, liquid calcium glubionate (Neo-Calglucon, Calcionate) or calcium gluconate is preferred. For older children and adolescents, the authors prefer calcium citrate over calcium carbonate because the latter is not well absorbed through the gut and it needs to be taken with a meal because it requires acid for absorption.

Calcium citrate (Cal-Citrate, Citracal)


Oral formulation usually used as supplementation to IV calcium therapy. Moderates nerve and muscle-performance by regulating action potential excitation threshold and facilitates normal cardiac function. Give amount needed to supplement diet to reach recommended daily amounts.

Calcium gluconate


Used to correct serum calcium concentration and relieve hypocalcemic symptoms. Moderates nerve and muscle performance and facilitates normal cardiac function (1 g = 90 mg elemental = 4.5 mEq elemental calcium).

Calcium glubionate (Neo-Calglucon)


PO calcium can be used to correct mild hypocalcemia and for maintenance therapy. Moderates nerve and muscle performance and facilitates normal cardiac function (1 g = 64 mg elemental = 3.3 mEq elemental calcium).

Calcium carbonate (Tums, Oscal)


An alternative PO form of calcium that can be used to correct mild hypocalcemia and for maintenance therapy (1 g = 400 mg elemental = 20 mEq elemental calcium).


Vitamin D supplements

Class Summary

1,25-Dihyroxyvitamin D, calcitriol, is critical for maintaining serum calcium concentrations. Parathyroid hormone (PTH) deficiency impairs conversion of inactive vitamin D to the active form by renal 1-alpha-hydroxylase. To bypass this PTH-dependent step, the active form of vitamin D is administered and may eliminate the need for PO calcium once the patient has stabilized.

Calcitriol (Rocaltrol, Calcijex)


This drug has a short half-life, and its effects are quickly reversed with withdrawal of the medication in case of hypercalcemia. Calcitriol is available in 0.25- and 0.50-mcg gel cap or an oral solution of 1 mcg/mL. Also available in an injectable form of 1 mcg/mL and 2 mcg/mL.

Contributor Information and Disclosures

Pisit (Duke) Pitukcheewanont, MD Associate Professor of Clinical Pediatrics, University of Southern California, Keck School of Medicine, Childrens Hospital Los Angeles

Pisit (Duke) Pitukcheewanont, MD is a member of the following medical societies: American Academy of Pediatrics, American Diabetes Association, American Medical Association, American Society for Bone and Mineral Research, Endocrine Society, Pediatric Endocrine Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) Professor and Chair, First Department of Pediatrics, Athens University Medical School, Aghia Sophia Children's Hospital, Greece; UNESCO Chair on Adolescent Health Care, University of Athens, Greece

George P Chrousos, MD, FAAP, MACP, MACE, FRCP(London) is a member of the following medical societies: American Academy of Pediatrics, American College of Physicians, American Pediatric Society, American Society for Clinical Investigation, Association of American Physicians, Endocrine Society, Pediatric Endocrine Society, Society for Pediatric Research, American College of Endocrinology

Disclosure: Nothing to disclose.

Chief Editor

Stephen Kemp, MD, PhD Former Professor, Department of Pediatrics, Section of Pediatric Endocrinology, University of Arkansas for Medical Sciences College of Medicine, Arkansas Children's Hospital

Stephen Kemp, MD, PhD is a member of the following medical societies: American Academy of Pediatrics, American Association of Clinical Endocrinologists, American Pediatric Society, Endocrine Society, Phi Beta Kappa, Southern Medical Association, Southern Society for Pediatric Research

Disclosure: Nothing to disclose.

Additional Contributors

Thomas A Wilson, MD Professor of Clinical Pediatrics, Chief and Program Director, Division of Pediatric Endocrinology, Department of Pediatrics, The School of Medicine at Stony Brook University Medical Center

Thomas A Wilson, MD is a member of the following medical societies: Endocrine Society, Pediatric Endocrine Society, Phi Beta Kappa

Disclosure: Nothing to disclose.

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Electrocardiogram (ECG) findings in severe hypocalcemia.
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