How are hypoparathyroidism and hypocalcaemia treated?

In general hypocalcaemia is treated with oral calcium and vitamin D supplements to keep blood calcium levels within the normal range and prevent the development of symptoms.Calcium carbonate is the cheapest form of oral calcium.  Calcium citrate is more expensive but its absorption is not affected by lack of gastric acidity (achlorhydria) a common problem in the elderly.We suggest that if calcium carbonte is used it is always taken with food. Patients who are on proton pump inhibitors should most likely take calcium citrate and not calcium carbonate.Specifically in hypoparathyroidism, the best vitamin D drug to use is calcitriol (1.25-dihydroxyvitamin D) as the kidney cannot efficiently process other forms when parathyroid hormone (PTH) levels are low.

In rare emergency circumstances, calcium may be given intravenously to make the patient safe. It is essential however that the calcium is infused through a large central IV line. On occasions calcium may leak through a vein (extravasate) if given by an arm IV line, causing irritation and possible local necrosis of muscle and nerves (calciphylaxis).

An example of calcium extravasation in right arm

In neglected cases this can cause gangrene of a limb.