In acute hypocalcaemia requiring systemic therapy calcium gluconate inj. is given as a 10% solution, 10-20 ml at the rate of about 2 ml per min and followed by a continuous i.v. infusion containing 40 ml (9 mmol) per day with monitoring of plasma calcium. It must not be given i.m. as it is painful and causes necrosis. Calcium glubionate (Calcium Sandoz) can be given by deep i.m. injection in adults.

For chronic use, e.g. hypoparathyroidism, alfa-calcidol or calcitriol are needed. Dietary calcium is increased by giving calcium gluconate (an effervescent tablet is available) or lactate. Aluminium hydroxide binds phosphate in the gut causing hypo-phosphataemia, which stimulates renal formation of the most active vitamin D metabolite and usefully enhances calcium absorption.

Adverse effects of intravenous calcium may be very dangerous. An early sign is a tingling feeling in the mouth and of warmth spreading over the body. Serious effects are those on the heart, which mimic and synergise with digitalis (fatal cardiac arrest may occur in digitalised animals) and it would seem advisable to avoid i.v. calcium in any patient on a digitalis glycoside (except in severe symptomatic hypocalcaemia). The effect of calcium on the heart is antagonised by potassium and similarly the toxic effects of a high serum potassium in acute renal failure may be to some extent counteracted with calcium.

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