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Hypocalcemia

General

Send child to Emergency Room if total calcium <1.8 mmol/L or > 1.8 and <2.0 with seizures
For most clinical situations, use the total calcium as the true calcium and the ionized for backup purposes. However, if there is an expectation that the albumin level may be low or if there are acid base abnormalities, rely more on the ionized calcium
Whom and when to refer to SickKids Hospital- see below

Definitions:

Our working definition of hypocalcemia is a total calcium less than  2.2mmol/L..  Please note: normal ranges may vary depending on the assay, the laboratory and age of the patient

  1. Severe

Total Calcium level < or equal to 1.8mmol/L and/or Ionized calcium < 0.8mmol/L

Recommendations

  1. Treatment

  • IV calcium infusion (see Sick Kids Handbook) is often required

  • Calcitriol 0.1 mcg/kg/day by mouth until calcium returns to normal range then reduce to 0.04mcg/kg/day

  • Calcium requirement by mouth based on age

  1. Investigations

  • Blood: serum calcium (total and ionized), phosphate, alkaline phosphatase, creatinine, 25 (OH) Vitamin D, 1, 25 (OH)2 Vitamin D, PTH

  • Urine (random); calcium/creatinine ratio

  • X ray L hand

  1. Consultation

  • Contact endocrine doctor or alternate on call to review treatment and investigations

  • Referral to Calcium Bone Clinic- see details below

  1. Moderately Severe

Total serum calcium between 1.8mmol/L and 2.0mmol/L

Recommendations

As for Severe Hypocalcemia above

  1. Borderline

Total Calcium between 2.0mmol/L and 2.2mmmol

Recommendation

Confirm with serum and urine investigations above (severe hypocalcemia)

Common causes of Hypocalcemia :

  • Vitamin D disorders

  • Hypoparathyroidism (Di George/Q 22 Deletion Syndrome)