Calcium Imbalance

Question 1

In severe acute hypocalcaemia or hypocalcaemic tetany, what should initially be given?

Answer 1

Initial slow IV of calcium gluconate injection,

with plasma calcium and ECG monitoring (risk of arrhythmias if given too rapidly)

Question 2

Which treatment for severe acute hypocalcaemia is more irritant? Calcium gluconate or calcium chloride?

Answer 2

Calcium chloride

Question 3

How should dehydration be corrected first? If oral hydration is not possible.

Answer 3

IV infusion of sodium chloride 0.9%

Question 4

If severe hypercalcaemia is persistent, which drugs that inhibit the mobilisation of calcium from the skeleton can be used?

Answer 4

Bisphosphonates, particularly Pamidronate disodium is probably the most effective

Question 5

When hypercalcaemia is due to sarcoidosis or vitamin D intoxication, which class of drugs is widely given?

Answer 5

Corticosteroids; they often take several days to achieve the desired effect.

Question 6

What can be given for the treatment of hypercalcaemia associated with malignancy?

Answer 6

Calcitonin; it is rarely effective where bisphonates have failed to reduce serum calcium adequately.

Question 7

How is idiopathic hypercalciuria managed?

Answer 7

Increasing fluid intake and giving bendroflumethiazide.