• Alan Ona MalabananEmail author


Hypocalcemia is common in the hospitalized patient and is associated with increased morbidity and mortality. Causes of hypocalcemia include vitamin D deficiency, hypoparathyroidism, hypomagnesemia, excessive urinary calcium losses, and inadequate intestinal calcium absorption. Symptomatic hypocalcemia is a medical emergency and is treated with intravenous calcium gluconate. Intravenous calcium gluconate is a temporary fix since calcium is freely filtered by the kidneys. Addressing the etiology of the hypocalcemia is important in managing hypocalcemia in the long term. Adequate calcium intake, along with calcitriol to aid with calcium absorption, is important in managing hypoparathyroidism. PTH therapy may be a useful adjunct to calcium and activated vitamin D in some patients. Post-thyroidectomy and post-parathyroidectomy hypocalcemia can be prevented by assuring adequate vitamin D stores preoperatively, assessing parathyroid function postoperatively and judiciously giving adequate supplemental calcium and calcitriol.


Hypocalcemia Vitamin D deficiency Parathyroid hormone Hypoparathyroidism 25-Hydroxyvitamin D Magnesium Hypomagnesemia Calcitriol Tetany Prolonged QT interval Laryngospasm Arrhythmia Chvostek’s sign Trousseau’s sign Malabsorption Hungry bone syndrome Thyroidectomy Parathyroidectomy 

Suggested Reading

  1. Cooper MS, Gittoes NJL. Diagnosis and management of hypocalcaemia. BMJ. 2008;336:1298–302. Scholar
  2. Mannstadt M, Bilezikian JP, Thakker RV, Hannan FM, Clarke BL, Rejnmark L, et al. Hypoparathyroidism. Nat Rev Dis Primers. 2017;3:17055. Scholar
  3. Mathur A, Nagarajan N, Kahan S, Schneider EB, Zeiger MA. Association of parathyroid hormone level with postthyroidectomy hypocalcemia: a systematic review. JAMA Surg. 2018;153:69–76. Scholar
  4. Ross DS, Burch HB, Cooper DS, Greenlee MC, Laurberg P, Maia AL, et al. 2016 American Thyroid Association guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis. Thyroid. 2016;26:1343–421. Scholar
  5. Witteveen JE, van Thiel S, Romijn JA, Hamdy NA. Therapy of endocrine disease: hungry bone syndrome: still a challenge in the post-operative management of primary hyperparathyroidism: a systematic review of the literature. Eur J Endocrinol. 2013;168:R45–53. Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Beth Israel Deaconess Medical Center, Harvard Medical School, Division of Endocrinology, Diabetes and MetabolismBostonUSA

Personalised recommendations