Long-term management of hypocalcaemia

Long-term treatment for hypocalcaemia with an oral calcium supplement, and a vitamin D supplement (calcitriol or colecalciferol) if appropriate, may be necessary if the cause of hypocalcaemia is permanent (eg damaged parathyroid gland). Clinical and biochemical monitoring every 6 months is usually sufficient for these patients.

Note: Aim for a serum calcium concentration at the lower limit or slightly below the reference range to avoid hypercalciuria and nephrocalcinosis.

The primary aim of ongoing therapy is to maintain symptom control, rather than achieve a target serum calcium concentration. A concentration at the lower limit of or slightly below the reference range is reasonable—attempting to normalise the serum calcium concentration can cause hypercalciuria and nephrocalcinosis. Kidney ultrasound to screen for nephrocalcinosis is recommended for all children who require ongoing therapy, and for adults if clinically indicated.

Discourage patients from consuming food or drink with a high phosphate content (eg soft drinks, sparkling water). Although some dairy products (eg milk) contain phosphate, moderate consumption is safe and a normal dietary calcium intake, as well as a high water intake, should be encouraged.