Calcium Correction - Hypocalcaemia (Not Resuscitation) UHL Paediatric Intensive Care Guideline - Library
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Calcium Correction - Hypocalcaemia
(Not Resuscitation) UHL Paediatric Intensive
Care Guideline
1.Introduction and to whom guideline applies
Calcium is one of the most abundant elements in the human body and has a wide
range of physiological roles including acting as enzyme co-factors, facilitating
neurotransmitter release, muscle contraction and in forming structural parts of the
body.
The majority of the body’s calcium is within the teeth and bones, with smaller
amounts in either intracellular stores or circulating in the blood. Of the fraction
circulating in the blood approximately 55% is bound to albumin or held in other
complexes; only 45% is free ionised calcium, which is the most physiologically
important component and gives the best indication of clinically significant
hypocalcaemia.
Calcium is normally absorbed from the diet and may be excreted from the kidneys.
Low levels may result from inadequate intake, poor absorption, excessive losses or
abnormal bone turnover. Homeostatic control of calcium levels is usually under the
control of parathyroid hormone and calcitonin. Abnormally low levels may need
intervention to correct them, for which this guideline intends to provide some
guidance.
The policy applies to all healthcare professionals involved in the prescribing and
administration of oral and injectable calcium supplements to patients within the
childrens’ hospital.
The guideline for the management of hypocalcaemia is only applicable paediatric
wards including intensive care areas.
Title: Calcium Correction – Hypocalcaemia (Not Resuscitation) UHL Paediatric Intensive Care Guideline 1 of 4
Version: 3 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C92/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL
Policies and Guidelines Library.
2.Treatment regimens & monitoring
Hypocalcaemia
Requires correction if:
1. Ionized calcium 1.5 mmol/L consider stopping treatment
Access:
Where possible administer calcium gluconate via a central line
Check that the central venous line bleeds back, or that the peripheral line flushes
easily, before administering
Look for evidence of leakage around cannula site
If administered centrally use the most distal lumen available
If using peripheral access check for extravasation every 15 minutes.
Compatibility:
Compatible with potassium
Compatible with inotropes
Children requiring calcium infusions should be monitored in an HDU or ICU
environment
Title: Calcium Correction – Hypocalcaemia (Not Resuscitation) UHL Paediatric Intensive Care Guideline 2 of 4
Version: 3 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C92/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL
Policies and Guidelines Library.Non-acute Hypocalcaemia
Consider calcium boluses via oral route in form of
Alliance Calcium Syrup (0.51mmols/ml)
(Full feeds not essential)
NIL BY MOUTH
Consider maintenance IV fluids.
or
IV calcium gluconate 1mmol/kg/day
Acute Hypocalcaemia
Calcium gluconate Calcium chloride
(1st line) intermittent infusion or (2nd line) intermittent
peripherally or centrally infusion centrally
0.11mmol/kg/dose (over 10 0.11mmol/kg/dose (over 10
minutes) minutes)
Check ionised calcium level following each intermittent infusion
If requiring multiple intermittent infusions to maintain calcium level, or for inotropic
use, a continuous central infusion of calcium gluconate 0.1-1mmol/kg/day can be
commenced (see IV monograph)
Ensure ionised calcium level is checked every 2- to 3- hours on blood gas samples
while the infusion is running, and periodically thereafter
Title: Calcium Correction – Hypocalcaemia (Not Resuscitation) UHL Paediatric Intensive Care Guideline 3 of 4
Version: 3 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C92/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL
Policies and Guidelines Library.3.Education and Training
None
4.Monitoring Compliance
None
5.Supporting References
None
6.Key Words
Calcium, Hypocalcaemia, Calcium Gluconate, Calcium Chloride
CONTACT AND REVIEW DETAILS
Guideline Lead (Name and Title) Executive Lead:
James Whitelaw - Consultant Paediatric Simon Robinson
Intensivist
Stephen Bennett - Senior Pharmacist
REVIEW RECORD
Description Of Changes (If Any)
Calcium gluconate stated as preferred option for non-arrest situations
Sandocal 1000 replaced with Alliance Calcium Syrup for non-urgent oral
replacement
Minor typographical, grammatical and typesetting changes
Title: Calcium Correction – Hypocalcaemia (Not Resuscitation) UHL Paediatric Intensive Care Guideline 4 of 4
Version: 3 Approved by PICU/CICU Clinical Practice Group: August 2018
Trust Ref: C92/2016 Next Review: August 2021
NB: Paper copies of this document may not be the most recent version. The definitive version is in the UHL
Policies and Guidelines Library.You can also read
