Hypocalcemia:
Correct Calcium Level=(4 – Albumin level) 0.8 + Lab Calcium level.
Check Vitamin D level, Phosphorus level
Give Calcium Gluconate or Calcium Chloride IV
PO Calcium Carbonate 1 tab 2-3 times a day
Vitamin D supplementation if low, Can give 50,000 units weekly for 4-6 weeks.
Calcitriol
Hypercalcemia:
ER:
Routine labs
IV Fluids
Hospitalist:
25 [OH]Vitamin D level
IV Lasix with iv fluids Maybe 150-200 cc/hr depending on patient’s volume status and tolerability. Do not give too much fluids for elderly for long.
Calcitonin
Bisphosphonates-4 mg IV zoledronic acid x 1 if her serum calcium is 12 or more
Look for cause-Pronounced elevation of Ca in certain cancers, mild elevation in dehydration and if on supplements
Phosphorus level, PTH, PTH-rp levels
Cancer screening in severe cases
Hold medications like Thiazide diuretic/HCTZ, Calcium supplements, Vitamin D supplements.
Nephrology:
Dialysis in severe cases
