Treatment of acute hypocalcemia in critically ill multiple-trauma patients.

Abstract

BACKGROUND:

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

• Authors: Roland N Dickerson, Laurie G Morgan, April D Cauthen, Kathryn H Alexander, Martin A Croce, Gayle Minard, Rex O Brown
• Journal: JPEN. Journal of parenteral and enteral nutrition (JPEN J Parenter Enteral Nutr) 2005 Nov-Dec Vol. 29 Issue 6 Pg. 436-41 ISSN: 0148-6071 [Print] United States
• PMID: 16224037 (Publication Type: Journal Article)

Chemical References

• Calcium Gluconate

Topics

• Acute Disease
• Calcium Gluconate (therapeutic use)
• Critical Illness (therapy)
• Dose-Response Relationship, Drug
• Female
• Humans
• Hypocalcemia (drug therapy, etiology)
• Infusions, Intravenous
• Intensive Care Units
• Male
• Middle Aged
• Multiple Trauma (therapy)
• Nutritional Support (adverse effects)
• Treatment Outcome