Hypocalcemia 81
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6. Nursing: Seizure precautions, weigh patient bid, measure inputs and outputs.
7. Diet: Restrict dietary calcium to 400 mg/d, push PO fluids.
8. Special Medications:
-1-2 L of 0.9% saline over 1-4 hours until no longer hypotensive, then saline
diuresis with 0.9% saline infused at 125 cc/h AND
-Furosemide (Lasix) 20-80 mg IV q4-12h. Maintain urine output of 200 mL/h;
monitor serum sodium, potassium, magnesium
-Calcitonin (Calcimar) 4-8 IV kg IM q12h or SQ q6-12h.
-Etidronate (Didronel) 7.5 mg/kg/day in 250 mL of normal saline IV infusion
over 2 hours for 3 days.
-Pamidronate (Aredia) 60 mg in 1 liter of NS infused over 4 hours or 90 mg
in 1 liter of NS infused over 24 hours x one dose.
9. Extras: CXR, ECG, mammogram.
10. Labs: Total and ionized calcium, SMA 7&12, phosphate, Mg, alkaline
phosphatase, prostate specific antigen. 24h urine calcium, phosphate,
parathyroid hormone.
Hypocalcemia
1. Admit to:
2. Diagnosis: Hypocalcemia
3. Condition:
4. Vital signs: q4h. Call physician if BP >160/90, <90/60; P >120, <50; R>25,
<10; T >38.5
C; or any abnormal mental status.
5. Activity: Up ad lib
6. Nursing: I and O.
7. Diet: No added salt diet.
8. Special Medications:
Symptomatic Hypocalcemia:
-Calcium chloride, 10% (270 mg calcium/10 mL vial) give 5-10 mL slowly over
10 min or dilute in 50-100 mL of D5W and infuse over 20 min, repeat q20-
30 min if symptomatic, or hourly if asymptomatic. Correct hyperphos-
phatemia before hypocalcemia OR
-Calcium gluconate, 20 mL of 10% solution IV (2 vials)(90 mg elemental
calcium/10 mL vial) infused over 10-15 min, followed by infusion of 60 mL
of calcium gluconate in 500 cc of D5W (1 mg/mL) at 0.5-2.0 mg/kg/h.
Chronic Hypocalcemia:
-Calcium carbonate with vitamin D (Oscal-D) 1-2 tab PO tid OR
-Calcium carbonate (Oscal) 1-2 tab PO tid OR
-Calcium citrate (Citracal) 1 tab PO q8h or Extra strength Tums 1-2 PO with
meals.
-Vitamin D2 (Ergocalciferol) 1 tab PO qd.
-Calcitriol (Rocaltrol) 0.25 mcg PO qd, titrate up to 0.5-2.0 mcg qid.
-Docusate sodium (Colace) 1 tab PO bid.
9. Extras: CXR, ECG.
