Hypocalcaemia can life threatening, due to arrhythmias and seizures.

Severity – Adjusted Calcium (Ca)

  • Mild: >1.9mmol/l
  • Severe: ≤1.9mmol/l OR Symptomatic


  • Paraesthesiae: peri-oral & digits
  • Trousseau’s sign (spasm of hand and wrist, when blood pressure cuff >20mmHg over systolic BP for 2-5min, very unpleasant for patient)
  • Chvostek’s sign (facial spasm  on tapping facial nerve, anterior to earlobe and below the zygomatic arch)
  • Tetany & carpopedal spasm
  • Laryngospasm
  • Dysrhythmias: Prolonged QT & arrhythmia
  • Seizures


  • Parathyroid disruption, is the commonest (either from parathyroid or thyroid pathologies)
  • Vit D deficiency
  • Rhabdomyolysis
  • Pancreatitis
  • Transfusion
  • Hypomagnesaemia


Mild: Adjusted Calcium >1.9mmol/l

  • Commence Oral Calcium supplementation
  • Treat underlying cause (send: Vit D, PTH, Mg, U&E, Phosphate)
  • Likely discharge to GP follow-up

Severe: Adjusted Calcium ≤1.9mmol/l OR Symptomatic

  • Calcium Gluconate
    • Initial – 10ml 10% Calcium Gluconate I.V. 10min (may be repeated until symptoms resolve)
    • Maintenance – 100ml 10% Calcium Gluconate diluted in 1000ml 0.9% NaCl/5% Glucose (10-20hours)
  • Treat underlying cause (send: Vit D, PTH, Mg, U&E, Phosphate)
  • Will need admision

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