Treatment of acute hypocalcemia in critically ill multiple-trauma patients.
BACKGROUND
Recent data indicate that critically ill, adult multiple trauma patients receiving specialized nutrition support commonly experience hypocalcemia (ionized serum calcium [iCa] < or =1.12 mmol/L). However, validated methods for the treatment of acute hypocalcemia are lacking.


METHODS
The efficacy of a single dose of calcium gluconate using an empiric IV calcium gluconate graduated dosing regimen was evaluated in 37 patients. Patients with an iCa of 1-1.12 mmol/L (mild hypocalcemia) were provided 1-2 g of IV calcium gluconate. Patients with an iCa of <1 mmol/L (moderate to severe hypocalcemia) were given 2-4 g. The calcium gluconate was infused at a rate of 1 g/h in a small-volume admixture. Serum iCa determination was repeated on the following day.


RESULTS
One to 2 g of IV calcium gluconate was effective in normalizing iCa for 23 out of 29 patients (79%) with mild hypocalcemia and 2-4 g was effective for 3 of 8 patients (38%) with moderate to severe hypocalcemia. The individual response to calcium therapy (g/d) or when normalized to body weight (mg/kg/d) was highly variable.


CONCLUSIONS
One to 2 g of IV calcium gluconate were effective for most patients with mild hypocalcemia; however, treatment of moderate to severe hypocalcemia with 2-4 g of IV calcium gluconate was often unsuccessful. Further study with frequent serial ionized serum calcium and phosphorus determinations and electrocardiographic monitoring appears to be indicated for patients with moderate to severe hypocalcemia.
Dickerson
Roland N
RN
Departments of Pharmacy and Surgery, University of Tennessee Health Science Center, Memphis, 38163, USA. rdickerson@utmem.edu
Morgan
Laurie G
LG
Cauthen
April D
AD
Alexander
Kathryn H
KH
Croce
Martin A
MA
Minard
Gayle
G
Brown
Rex O
RO
D000208:Acute Disease; D002125:Calcium Gluconate / Q000627:therapeutic use*; D016638:Critical Illness / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy* / Q000209:etiology; D007262:Infusions, Intravenous; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000628:therapy*; D018529:Nutritional Support / Q000009:adverse effects*; D016896:Treatment Outcome
D002125:Calcium Gluconate