eMedicine Specialties > Pediatrics: General Medicine > Endocrinology
Hypoparathyroidism: Treatment & Medication
Updated: Sep 17, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
- Symptomatic hypocalcemia (eg, seizure, tetany, laryngospasm) in patients with hypoparathyroidism requires intravenous calcium and continuous monitoring for cardiac arrhythmias.
- Oral calcium and vitamin D should be initiated as soon as possible (eg, when the patient is tolerating oral feeds).
- Once serum calcium concentrations are in a safe range (>7.5 mg/dL), intravenous calcium can be stopped. However, rebound hypocalcemia can occur and requires that a patient be monitored for therapeutic success on oral agents for at least 24 hours after intravenous calcium is withdrawn.
- The active form of vitamin D, 1,25-dihydroxyvitamin D, is preferred in the treatment of hypoparathyroidism because both the parathyroid hormone (PTH) deficiency/resistance and the hyperphosphatemia impair the activation of 25-hydroxyvitamin D by 1-alpha-hydroxylase.
Diet
- No special diet is required, but adequate calcium and vitamin D intake is recommended.
Medication
Calcium and 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.
Calcium supplements
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.
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).
Adult
100-300 mg elemental calcium IV diluted in 150 mL D5W over 10 min; initial rate of infusion should be 0.3-2 mg of elemental calcium/kg/h
Pediatric
10% calcium gluconate solution (contains 9 mg/mL elemental calcium), 9-15 mg elemental/kg IV over 30 - 120 min initially; then 100 mg elemental/kg/d PO/IV (initially maximum IV dose of 60 mg elemental/kg/d should be administered for severe hypocalcemia until transition to PO dosing is safe)
May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; antagonizes effects of verapamil; large intakes of dietary fiber may decrease calcium 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
Rapid IV bolus may affect cardiac conduction, careful cardiac monitoring is necessary when IV calcium is administered; use extravasation precautions; caution in digitalized patients, respiratory failure, acidosis, or severe hyperphosphatemia
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).
Adult
1-2 g/d elemental calcium PO divided tid/qid
Pediatric
100 mg elemental calcium/kg/d PO initially, then wean as necessary
Infants: 60 mg/kg/d PO elemental calcium
Older children: Require less per kg than infants; dose should be adjusted individually to maintain serum calcium levels at low end of the reference range for your laboratory
May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; antagonizes effects of verapamil; large intakes of dietary fiber may decrease calcium 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
May cause hypercalcemia or hypercalcuria
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).
Adult
1-2 g/d elemental calcium PO divided tid/qid
Pediatric
100 mg elemental calcium/kg/d PO initially, then wean as necessary
Infants: 60 mg/kg/d PO elemental calcium
Older children: Require less per kg than infants; dose should be adjusted individually to maintain serum calcium levels at the low end of the reference range for your laboratory
May decrease effects of tetracyclines, atenolol, salicylates, iron salts, and fluoroquinolones; antagonizes effects of verapamil; large intakes of dietary fiber may decrease calcium 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
May cause hypercalcemia or hypercalcuria
Vitamin D supplements
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.
Calcitrol (Rocaltrol)
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.
Adult
0.5-2 mcg PO qd
Pediatric
25-50 ng/kg/d PO divided qid; usual dose is 0.25-mcg gel cap qid to treated hypoparathyroidism
Cholestyramine and colestipol decrease absorption of calcitriol; magnesium-containing antacids and thiazide diuretics can increase calcitriol effects
Documented hypersensitivity; hypercalcemia; malabsorption syndrome; vitamin D intoxication
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
Adequate response to calcitriol depends on adequate dietary calcium intake; maintain adequate fluid intake
More on Hypoparathyroidism |
| Overview: Hypoparathyroidism |
| Differential Diagnoses & Workup: Hypoparathyroidism |
 Treatment & Medication: Hypoparathyroidism |
| Follow-up: Hypoparathyroidism |
| Multimedia: Hypoparathyroidism |
| References |
| « Previous Page | Next Page » |
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Further Reading
Keywords
hypoparathyroidism, hypocalcemia, pseudohypoparathyroidism, PHP, pseudopseudohypoparathyroidism, PPHP, polyglandular autoimmune endocrinopathy, DiGeorge syndrome, Barakat syndrome, Kenny-Caffey syndrome, Albright hereditary osteodystrophy, parathyroid insufficiency, familial hypercalciuric hypocalcemia, familial isolated hypoparathyroidism, calcium-sensing receptor hypocalcemia, Kearns-Sayre syndrome, Pearson marrow pancreas, laryngospasm, syncope, seizure, tetany, muscle aches, facial twitching, carpopedal spasm, tetralogy of Fallot, truncus arteriosus, Albright hereditary osteodystrophy, AHO, obesity, treatment, diagnosis
