Treatment of acute hypocalcemia in critically III multiple-trauma patients

Roland Dickerson, Laurie G. Morgan, April D. Cauthen, Kathryn H. Alexander, Martin Croce, Gayle Minard, Rex O. Brown

Research output: Contribution to journalArticle

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Abstract

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 mniol/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.

Original languageEnglish (US)
Pages (from-to)436-441
Number of pages6
JournalJournal of Parenteral and Enteral Nutrition
Volume29
Issue number6
DOIs
StatePublished - Nov 1 2005

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hypocalcemia
Hypocalcemia
Multiple Trauma
Calcium Gluconate
Calcium
calcium
Serum
Therapeutics
calcium gluconate
Critical Illness
Phosphorus
Body Weight
nutrition
phosphorus
therapeutics
body weight
monitoring

All Science Journal Classification (ASJC) codes

  • Food Science
  • Medicine (miscellaneous)

Cite this

Treatment of acute hypocalcemia in critically III multiple-trauma patients. / Dickerson, Roland; Morgan, Laurie G.; Cauthen, April D.; Alexander, Kathryn H.; Croce, Martin; Minard, Gayle; Brown, Rex O.

In: Journal of Parenteral and Enteral Nutrition, Vol. 29, No. 6, 01.11.2005, p. 436-441.

Research output: Contribution to journalArticle

Dickerson, Roland ; Morgan, Laurie G. ; Cauthen, April D. ; Alexander, Kathryn H. ; Croce, Martin ; Minard, Gayle ; Brown, Rex O. / Treatment of acute hypocalcemia in critically III multiple-trauma patients. In: Journal of Parenteral and Enteral Nutrition. 2005 ; Vol. 29, No. 6. pp. 436-441.
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abstract = "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 mniol/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.",
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N2 - 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 mniol/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.

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