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Efficacy of calcium replacement in hypocalcaemia

Introduction

The aim of the study is to examine the efficacy of calcium replacement in patients with hypocalcaemia in the ICU. Hypocalcaemia affects between 15 and 50% of admissions to the ICU [1].

Methods

Adjusted calcium results <2.0 mmol/l were followed up from admission for 5 days or until discharge or death. On each day the adjusted calcium result and the calcium replacement were documented. Adequate replacement is defined as 40 ml of 10% calcium gluconate if the adjusted calcium is <2.0 mmol/l and 20 ml of 10% calcium gluconate if the adjusted calcium result is between 2.0 and 2.15 mmol/l.

Results

Eighty-eight adjusted calcium results were <2.0 mmol/l. In 74 results adequate replacement was given and the average increase in calcium was 0.2 mmol/l. This led to an increase in the adjusted calcium to >2.15 mmol/l in 36% of results and improvement to >2.0 mmol/l in 89% of results. In 14 results no replacement was given and the average increase in calcium was 0.07 mmol/l, which equated to 57% of calcium results remaining <2.0 mmol/l. Unpaired t test showed a P value of 0.0006. A total of 150 adjusted calcium results were between 2.0 and 2.15 mmol/l. In 111 results adequate replacement was given and the average increase was 0.006 mmol/l. The adjusted calcium fell to <2.0 mmol/l in 26% of results and normalised to >2.15 mmol/l in 23%. Where the adjusted calcium fell despite replacement, 51% of results were below 2.05 mmol/l. In 39 results no replacement was given, leading to an average fall in calcium of 0.03 mmol/l. Thirty-three percent of calcium results fell to <2.0 mmol/l and 20% of results normalised. Unpaired t test showed a P value of 0.07.

Conclusion

Calcium replacement with 40 ml of 10% calcium gluconate is effective when the adjusted calcium is <2.0 mmol/l. Replacement with 20 ml of 10% calcium gluconate when the adjusted calcium is between 2.0 and 2.15 mmol/l is not much more effective than no replacement. This suggests that either replacement is not needed or there is under-replacement in mild hypocalcaemia. Adjusted calcium may be giving falsely low calcium results in mild hypocalcaemia. The measurement of ionised calcium is a possible solution [2, 3].

References

  1. 1.

    Zaloga GP: Crit Care Med. 1992, 20: 251-262. 10.1097/00003246-199202000-00014

    Article  CAS  PubMed  Google Scholar 

  2. 2.

    Slomp J, et al.: Crit Care Med. 2003, 31: 1389-1393. 10.1097/01.CCM.0000063044.55669.3C

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Byrnes MC, et al.: Am J Surg. 2005, 189: 310-314. 10.1016/j.amjsurg.2004.11.017

    Article  CAS  PubMed  Google Scholar 

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Correspondence to H Chatha.

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Chatha, H., Sim, K. Efficacy of calcium replacement in hypocalcaemia. Crit Care 17, P449 (2013). https://doi.org/10.1186/cc12387

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Keywords

  • Public Health
  • Calcium
  • Emergency Medicine
  • Ionise Calcium
  • Calcium Result