Pediatric Hypocalcemia Treatment & Management

Updated: Oct 25, 2021
  • Author: Yogangi Malhotra, MD; Chief Editor: Sasigarn A Bowden, MD  more...
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Approach Considerations

Treatment of asymptomatic patients with hypocalcemia remains controversial, especially with regard to neonates. Some authorities suggest that treating such patients is unnecessary. Most newborns with hypocalcemia remain asymptomatic and can be treated in a regular newborn nursery. If persistent, the newborns can be treated with special formula PM 60/40 that provides 2:1 calcium-to-phosphate ratio. Oral calcium supplements can be added to increase the calcium-to-phosphorus ratio to 4:1 to correct the hypocalcemia until PTH function normalizes.

Most clinicians agree, however, that hypocalcemia should be promptly treated in any symptomatic neonate or older child because of the condition’s serious implications for neuronal and cardiac function. Any child with symptomatic hypocalcemia should be admitted to the hospital unless the diagnosis is hyperventilation.

Oral calcium therapy is used in asymptomatic patients and as follow-up to intravenous (IV) calcium therapy. IV treatment is usually indicated in patients having seizures, those who are critically ill, and those who are planning to have surgery.

However, IV infusion with calcium-containing solutions can cause severe tissue necrosis; this can result in contractures and may require skin grafting. Integrity of the IV site should be ascertained before administering calcium through a peripheral vein.

Necrosis of the liver can occur after calcium infusion through an umbilical vein catheter placed in a branch of the portal vein. The position of all umbilical vein catheters must be confirmed on a radiograph before infusing calcium-containing solutions.

Rapid infusion of calcium-containing solutions through arterial lines can cause arterial spasm and, if administered via an umbilical artery catheter, intestinal necrosis.


General medical care in patients with hypocalcemia involves stabilization with management of the patient's airway and breathing if seizures occur. Anticonvulsants are commonly administered before hypocalcemia is confirmed in a new patient. However, seizures usually do not respond to the usual antiepileptic medications until calcium is intravenously administered.

Additional considerations

Magnesium administration is necessary to correct any hypomagnesemia because hypocalcemia does not respond until the low magnesium level is corrected.

Administration of phosphate-lowering agents may be necessary if hypocalcemia is associated with hyperphosphatemia.

In certain conditions, such as pancreatitis and rhabdomyolysis, full correction of hypocalcemia should be avoided. After the primary condition is resolved, these patients may develop hypercalcemia due to the release of complexed calcium.

In patients with concurrent acidemia, hypocalcemia should be corrected first. Acidemia increases the ionized calcium levels by displacing calcium from albumin. If acidemia is corrected first, ionized calcium levels decrease.

Vitamin D analogs may be appropriate in increasing intestinal absorption of calcium.

Replacement therapy with PTH has recently become available. The recombinant human PTH (1-84) allows for better control of serum calcium without the need for high doses of oral calcium and Vit D, and with possible prevention of long term consequences like renal and brain calcifications.  [16]


A diet high in calcium and low in phosphate is required in most instances. Infants drinking regular cow's milk or evaporated milk must be given humanized infant formula instead. Patients with renal failure should be given a low-solute, low-phosphate formula, such as Similac PM 60/40.


Consult with the follow specialists as needed:

  • Pediatric endocrinologist

  • Geneticist