Treatment of Moderate to Severe Acute Hypocalcemia in Critically Ill Trauma Patients

Abstract

Background: Our recent data indicate that 21% of critically ill, adult, multiple-trauma patients receiving specialized nutrition support experience hypocalcemia. However, evidence-based methods for the treatment of moderate to severe acute hypocalcemia (ionized calcium concentration [iCa]<1 mmol/L) are lacking. Methods: The efficacy of an infusion of 4 g of calcium gluconate was evaluated in 20 critically ill, adult, multiple-trauma patients with moderate to severe hypocalcemia (iCa <1 mmol/L). The calcium gluconate was infused at a rate of 1 g/h in a small volume admixture. A serum iCa determination was obtained on the following day. Results: Calcium gluconate infusion significantly increased serum iCa from 0.90 ± 0.08 mmol/L to 1.16 ± 0.11 mmol/L (p < .001) on the following day. This dosage regimen was successful for achieving a serum iCa >1 mmol/L for 19 of 20 (95%) hypocalcemic patients and achieved a concentration >1.12 mmol/L in 14 (70%) of the patients. Two patients developed mild hypercalcemia (iCa of 1.34 mmol/L and 1.38 mmol/L) postinfusion. Conclusions: A short-term infusion of 4 g of intravenous (IV) calcium gluconate for the treatment of moderate to severe hypocalcemia appears to be a promising regimen for critically ill, adult, multiple-trauma patients.

The efficacy of a 4-g IV calcium gluconate infusion for moderate to severe hypocalcemia was examined in 20 trauma intensive care unit patients. This dosage was successful for achieving a serum ionized calcium concentration >1 mmol/L for 19 of 20 (95%) patients.