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Treatment of Moderate to Severe Acute Hypocalcemia in Critically Ill Trauma Patients

Roland N. Dickerson, PharmD^*, Laurie M. Morgan, RN, 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 Department of Pharmacy, Regional Medical Center at Memphis, Memphis, Tennessee

Correspondence: Roland N. Dickerson, PharmD, BCNSP, FACN, FCCP, 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: 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.

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