Treatment of hypocalcemia generally involves elucidating the cause for the inability to maintain normal levels of blood calcium, followed by correction of the problem. The most common cause of a low blood calcium is inadequate function of or damage to or surgical removal of the parathyroid glands. As most patients have 4 parathyroid glands, the function of at least 3 or more glands needs to be compromised before hypocalcemia develops. In most cases, treatment with oral calcium supplementation is effective in restoring the blood calcium to normal. In some instances, vitamin D supplements may be prescribed to enhance absorption of the calcium supplement. There are many different forms of calcium preparations, and similarly, there are several different types of vitamin D tablets. Generally, patients should strive to be maintained on the lowest doses of calcium and vitamin D that maintains their calcium in the normal range and allows patients to feel well without symptoms of hypocalcemia. Although patients may feel entirely well on high doses of calcium and vitamin D, it is important to periodically monitor kidney function in this scenario. Patients taking too much calcium and vitamin D may sometimes have too much calcium filtered through their kidneys, which over the long term may slightly increase the risk of kidney stones and impairment of kidney function. Hence periodic monitoring of kidney function through blood tests, and calcium excretion in the urine through urine collections, may be indicated in selected individuals.
If urine calcium excretion in the urine proves to be excessive, some patients may benefit from a reduction in the dose of vitamin D or calcium, however the levels of blood calcium and clinical well being of the patient should be carefully monitored when any changes in the doses of medications are implemented. Alternatively, some patients will derive benefit from taking small doses of a class of medications termed diuretics. These medicines, especially thiazide diuretics, will reduce urine calcium excretion and may be helpful in the long term management of some patients with severe hypocalcemia.