## Management of Acute Symptomatic Hypocalcemia Post-Thyroidectomy ### Clinical Context Postoperative hypocalcemia due to hypoparathyroidism (from inadvertent parathyroid gland injury or devascularization) is a common complication of thyroid surgery. Symptomatic hypocalcemia with tetany, paresthesia, and positive Chvostek's sign requires immediate intervention. ### Drug of Choice: Intravenous Calcium Gluconate **Key Point:** Intravenous calcium gluconate is the first-line agent for acute symptomatic hypocalcemia because it provides rapid, direct elevation of serum ionized calcium and can be administered safely through peripheral veins. **High-Yield:** - **Dose:** 10–20 mL of 10% calcium gluconate in 50–100 mL of normal saline, infused slowly IV over 10–20 minutes under cardiac monitoring. - **Onset:** Immediate (minutes). - **Monitoring:** ECG changes (shortening of QT interval) indicate adequate calcium repletion; stop infusion if hypercalcemia develops. ### Why Calcium Gluconate Over Calcium Chloride? | Feature | Calcium Gluconate | Calcium Chloride | |---------|-------------------|------------------| | **Peripheral IV use** | Safe | Causes tissue necrosis; central line only | | **Ionized calcium** | 9% elemental calcium | 27% elemental calcium | | **Clinical preference** | First-line | Reserved for central access | **Clinical Pearl:** Always check serum magnesium; hypomagnesemia impairs PTH secretion and must be corrected (MgSO₄ IV) for calcium repletion to be effective. ### Subsequent Management Once acute symptoms resolve, transition to oral calcium supplementation (calcium carbonate 1–2 g elemental calcium TID with meals) and calcitriol (0.25–0.5 μg BID) for sustained correction of hypoparathyroidism. **Mnemonic:** **ACUTE HYPO-Ca** = **IV Gluconate (Rapid), then Oral + Calcitriol (Sustained)** [cite:Sabiston Textbook of Surgery Ch 39]
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