The reference range for adjusted serum calcium is 2.1–2.6mmol/L. Hypocalcaemia may be due to deficiencies of calcium homeostatic mechanisms, secondary to high phosphate levels or other causes.
Recommended daily dose of elemental calcium is 1–3g (approximately 25–75mmol) daily.
Calcium salts – up to 50mmol daily in 2–3 divided doses. For example: Sandocal-1000, 1–2 tablets (25–50mmol) in water (other preparations are available).
If oral replacement is ineffective after 2–3 days in asymptomatic patients, add in: Alfacalcidol oral 1microgram daily (elderly 500nanograms).
Calcium gluconate 10% 10ml (2.2mmol calcium) over at least 10 minutes with cardiac monitoring.
Start a continuous infusion of 40ml (8.8mmol) of calcium gluconate 10% in 1 litre of sodium chloride 0.9% or glucose 5% over 24 hours.