GGC Medicines

Adult Therapeutics Handbook

Management of Hypocalcaemia

Management of Hypocalcaemia


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.

Assessment / monitoring

  • Plasma calcium level
  • Establish cause of hypocalcaemia and seek senior advice if necessary
  • Assess whether patient is symptomatic (e.g. tetany)

Drug therapy / treatment options

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).

Intravenous – for hypocalcaemic tetany


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.