Treatment of moderate to severe acute hypocalcemia in critically ill trauma patients.
BACKGROUND
Our recent data indicate that 21% of critically ill, adult, multiple-trauma patients receiving specialized nutrition support experience hypocalcemia. However, evidence-based methods for the treatment of moderate to severe acute hypocalcemia (ionized calcium concentration [iCa] <1 mmol/L) are lacking.


METHODS
The efficacy of an infusion of 4 g of calcium gluconate was evaluated in 20 critically ill, adult, multiple-trauma patients with moderate to severe hypocalcemia (iCa <1 mmol/L). The calcium gluconate was infused at a rate of 1 g/h in a small volume admixture. A serum iCa determination was obtained on the following day.


RESULTS
Calcium gluconate infusion significantly increased serum iCa from 0.90 +/- 0.08 mmol/L to 1.16 +/- 0.11 mmol/L (p < .001) on the following day. This dosage regimen was successful for achieving a serum iCa >1 mmol/L for 19 of 20 (95%) hypocalcemic patients and achieved a concentration >1.12 mmol/L in 14 (70%) of the patients. Two patients developed mild hypercalcemia (iCa of 1.34 mmol/L and 1.38 mmol/L) postinfusion.


CONCLUSIONS
A short-term infusion of 4 g of intravenous (IV) calcium gluconate for the treatment of moderate to severe hypocalcemia appears to be a promising regimen for critically ill, adult, multiple-trauma patients.
Dickerson
Roland N
RN
Department of Pharmacy, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. rdickerson@utmem.edu
Morgan
Laurie M
LM
Croce
Martin A
MA
Minard
Gayle
G
Brown
Rex O
RO
D000208:Acute Disease; D000328:Adult; D002118:Calcium / Q000097:blood*; D002125:Calcium Gluconate / Q000627:therapeutic use*; D016638:Critical Illness; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000188:drug therapy*; D007262:Infusions, Intravenous; D008297:Male; D009104:Multiple Trauma; D016896:Treatment Outcome
D002125:Calcium Gluconate; D002118:Calcium