Hypoparathyroidism in Emergency Medicine Treatment & Management

Updated: Aug 05, 2015
  • Author: Agnieszka Gliwa, MD; Chief Editor: Erik D Schraga, MD  more...
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Treatment

Prehospital Care

See the list below:

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

Recent guidelines on chronic hypoparathyroidism by the European Society of Endocrinology are below: [45]

  • Consider a diagnosis of chronic hypoparathyroidism (HypoPT) in a patient with hypocalcemia and inappropriately low parathyroid hormone (PTH) levels.
  • Consider genetic testing and/or family screening in a patient with HypoPT of unknown etiology.
  • Treatment targeted to maintain serum calcium level (albumin adjusted total calcium or ionized calcium) in the lower part or slightly below the lower limit of the reference range (target range) is suggested, with patients being free of symptoms or signs of hypocalcemia.
  • Treat patients with chronic HypoPT with symptoms of hypocalcemia and/or an albumin adjusted serum calcium level <2.0 mmol/L (<8.0 mg/dL/ionized serum calcium levels [S-Ca 2] <1.00 mmol/L).
  • Offer treatment to asymptomatic patients with chronic HypoPT and an albumin adjusted calcium level between 2.0 mmol/L (8.0 mg/dL/S-Ca 2+ 1.00 mmol/L) and the lower limit of the reference range in order to assess whether this may improve their well-being.
  • Use activated vitamin D analogues plus calcium supplements in divided doses as the primary therapy.
  • If activated vitamin D analogues are not available, treat with calciferol (preferentially cholecalciferol).
  • Titrate activated vitamin D analogues or cholecalciferol in such a manner that patients are without symptoms of hypocalcaemia and serum calcium levels are maintained within the target range.
  • Provide vitamin D supplementations in a daily dose of 400–800 IU to patients treated with activated vitamin D analogues.
  • In a patient with hypercalciuria, consider a reduction in calcium intake, a sodium-restricted diet, and/or treatment with a thiazide diuretic.
  • In a patient with renal stones, evaluate renal stone risk factors and management according to relevant international guidelines.
  • In a patient with hyperphosphatemia and/or an elevated calcium-phosphate product, consider dietary interventions and/or adjustment of treatment with calcium and vitamin D analogues.
  • In a patient with hypomagnesemia, consider measures that may increase serum magnesium levels.
  • The routine use of replacement therapy with PTH or PTH analogues is not recommended.

Care to prevent long-term complications from hypocalcemia or hypercalcemia [46] 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.
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Consultations

Consult an endocrinologist.

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