Hypercalcemia and Hypocalcemia admission

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