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Treatment of Acute Hypocalcemia in Critically Ill Multiple-Trauma Patients

Roland N. Dickerson, PharmD^*, Laurie G. Morgan, RN, April D. Cauthen, PharmD^*, Kathryn H. Alexander, MS, RD, Martin A. Croce, MD, Gayle Minard, MD and Rex O. Brown, PharmD^*

From the ^* Departments of Pharmacy and Surgery, University of Tennessee Health Science Center, Memphis, Tennessee; and the Departments of Pharmacy and Food and Nutrition, Regional Medical Center at Memphis, Memphis, Tennessee

Correspondence: Roland N. Dickerson, PharmD, Professor of Pharmacy, University of Tennessee Health Science Center, 26 South Dunlap St., Room 210, Memphis, TN 38163. Electronic mail may be sent to rdickerson{at}utmem.edu.

Background: Recent data indicate that critically ill, adult multiple trauma patients receiving specialized nutrition support commonly experience hypocalcemia (ionized serum calcium [iCa] 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.

Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 6, 436-441 (2005)
DOI: 10.1177/0148607105029006436


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