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Hypocalcaemia

Also known as: low calcium · hypocalcemia · tetany

A low serum calcium producing neuromuscular irritability — paraesthesia, cramps, carpopedal spasm, Chvostek's and Trousseau's signs, and (if severe) tetany, seizures or arrhythmia (long QT).

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

Hypoparathyroidism (including after thyroidectomy), vitamin D deficiency, chronic kidney disease, hypomagnesaemia, acute pancreatitis and large-volume transfusion.

Red flags — escalate / refer

Tetany, seizures, laryngospasm/stridor, or arrhythmia/long QT → emergency IV calcium.

Work-up / diagnosis

1Confirm with corrected or ionised calcium.
2Check magnesium, phosphate, renal function, PTH and vitamin D; ECG for a prolonged QT.

Management — overview

Severe or symptomatic → IV calcium with cardiac monitoring.
ALWAYS correct a low magnesium — calcium will not rise until magnesium is replaced.
Mild/chronic → oral calcium and vitamin D (an activated vitamin D in hypoparathyroidism or CKD); treat the cause.

In-depthFull dosing & advanced protocol

Drug dosing

IV calcium (gluconate)

Symptomatic / severe hypocalcaemia

Adult dose: Per protocol, with ECG monitoring
Route: Intravenous

Caution: Monitor the ECG; extravasation causes tissue injury.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

Oral calcium + vitamin D (± magnesium)

Maintenance / mild disease

Adult dose: Per protocol; replace magnesium if low
Route: Oral / IV (magnesium)

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

Replace magnesium first; watch the QT

Refractory hypocalcaemia is often due to unrecognised hypomagnesaemia — replace magnesium.
Distinguish PTH-related from vitamin-D-related causes to guide long-term treatment.
Post-thyroidectomy hypocalcaemia needs monitoring; a long QT can precede arrhythmia.

ICMRStandard Treatment Workflows (STWs), India — Dept. of Health Research & ICMR (2022+) ↗

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV calcium (gluconate)

Oral calcium + vitamin D (± magnesium)

📈 Replace magnesium first; watch the QT

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

IV calcium (gluconate)

Oral calcium + vitamin D (± magnesium)

📈 Replace magnesium first; watch the QT

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Replace magnesium first; watch the QT

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

Replace magnesium first; watch the QT

References