Via enteral feeding tube*: dissolve tablet(s) in 30 to 50mL water. Stopping feed is not required.Give oral calcium supplements outwith mealtimes.Consider alfacalcidol if patient has renal failure. THENIV 50mL (11·25mmol) calcium gluconate 10% injection given in 500mL sodium chloride 0.9% or glucose 5% infusion over 4 hours.Further bolus doses of calcium may be required after the infusion depending on symptoms and plasma calcium and magnesium levels.
|Adjusted Calcium Level
|2·0 to 2·25mmol/L
||Oral: Sandocal® 1000, 1 to 2 tablets (25 to 50mmol calcium) daily.
||Recheck adjusted calcium after 24 hours.
|Less than 2·0mmol/L
||IV 50mL (11·25mmol) calcium gluconate 10% in 500mL sodium chloride 0.9% or glucose 5% infusion over 4 hours.
||Recheck adjusted calcium 60 minutes after end of infusion.
||10mL (2·25mmol) calcium gluconate 10% injection given as an IV bolus over 5 minutes
||Recheck adjusted calcium and magnesium levels 60 minutes after end of infusion.
All infusions must be administered via an infusion pump.
ECG monitoring generally not required unless hypocalcaemic tetany is evident (see below) or patient is taking digoxin, due to interaction with calcium.
- Calcium is irritant to tissues (less irritant the more it is diluted). Regular checks should be made for evidence of extravasation. Check venflon is in a large vein and working well and that the infusion is running well before and during administration of IV calcium.
- Calcium gluconate 10% injection = 2·25mmol calcium/10mL.
- Patients with more severe hypocalcaemia may need oral supplements of oral calcium and/or alfacalcidol as well as IV treatment to prevent calcium deficiency returning.
- *Note that absorption may be reduced if administered via jejunal feeding tube.