This protocol addresses patients with acute hypocalcemia who are asymptomatic and have a serum calcium above 1.9 mmol/L — the presentation classified as mild hypocalcaemia. The absence of symptoms and the degree of calcium reduction together define this specific clinical situation.
Management centres on oral calcium supplementation. The choice of agent and the additional interventions required depend on the underlying cause — including whether vitamin D status or magnesium levels are contributing. The complete agent selection, cause-directed adjustments, and full regimen are contained in the structured protocol below.
Success is defined by confirmation of calcium normalisation on follow-up testing and, where hypomagnesaemia is involved, restoration of a normal serum magnesium level. The specific reassessment timing and thresholds are set out in the full protocol.
DOI: 10.1530/EC-16-0056
'Mild' hypocalcaemia: asymptomatic; serum calcium >1.9 mmol/L.
Commence oral calcium supplements such as Sandocal 1000, 2 tablets BD (Alternatives include Adcal 3 tablets BD, Cacit 4 tablets BD, or Calcichew Forte 2 tablets BD).
If vitamin D deficiency is the cause, commence vitamin D supplementation: load with ~300,000 units of cole- or ergocalciferol over ~6–10 weeks.
If hypomagnesaemia-related, stop any precipitating drug and administer i.v. Mg2+, 24 mmol/24 h, made up as 6 g of MgSO4 (30 mL of 20%, 800 mmol/L, MgSO4) in 500 mL Normal saline or 5% dextrose.
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