PLACE LABEL HERE
HYPOCALCEMIA
POST THYROIDECTOMY / PARATHYROIDECTOMY
PROTOCOL
The following orders will be implemented per physician order of this protocol.
Orders with a “” are indicator choices and are NOT implemented unless checked.
Initial the bottom of each page when indicated (multipage).
Serum Calcium Level
Medication
Recheck Calcium Level
Calcium level: 8 - 8.5
- Administer Calcium Carbonate 1,000 mg
(2 x 500 mg tablets) po BID
- Next AM
Calcium level: 7.5 - 7.9
- Administer Calcium Carbonate 1,000mg
(2 x 500 mg tablets) po BID
and
- Rocaltrol (calcitriol) 0.25 mcg po BID
- Next AM
Calcium level: 7 - 7.4
- Administer Calcium Carbonate 1,000mg
(2 x 500 mg tablets) po four times daily
and
- Rocaltrol (calcitriol) 0.25 mcg po BID
- 4 hrs
- If calcium level remains > 7,
continue same medications
and recheck calcium in AM
Calcium level: < 7
or
Patient has symptoms of
hypocalcemia:
- Administer Calcium Carbonate 1,000mg
(2 x 500 mg tablets) po four times daily
-
EKG monitoring
-
STAT Ionized calcium per
respiratory therapy and call
results to physician
-
Calcium levels q 4 hrs and if
patient remains symptomatic,
call physician in am
-
Discontinue calcium infusion
when calcium > 7.5

- Numbness or tingling especially
of fingers, hands, and toes
- Acute tetany with possible
seizures
- Positive Chvostek’s sign (tapping
of facial nerve elicits twitching of
facial muscles especially around
the mouth)
- Positive Trousseau’s sign
(spasm of the hand in a claw
type appearance. May be
elicited when blood pressure cuff
is elevated at systolic for 3
minutes)
- Muscle cramps
- Bronchospasm
and
- Rocaltrol (calcitriol) 0.5 mcg po BID
and
- Calcium Gluconate 10%, 1 gm diluted in NS 50
ml IV over 15 min
followed by
- Calcium Gluconate 10%, 4 gm diluted in NS
1,000 ml at 100 ml/hr
-
STAT Magnesium (Mg) level
If Mg level < 1.8, administer Magnesium
Sulfate 2 grams IVPB x 1 dose
Nurse: Write a new order for each needed dose and lab, sign “Per Dr. X’s order/Your Name, RN”
______________
Date
___________________
Time
_________________________________
Physician Signature
___________
PID Number
Copy to pharmacy
*1-21121*
1
FORM 1-21121 REV. 08/2014
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Send copy to pharmacy____________________ (initials)
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