下面資料來自uptodate(僅節錄部分), 中文是先用google翻譯之後再修改.
嚴重症狀和/或急性低鈣血症 — 我們建議靜脈注射 (IV) 鈣劑治療以下患者的低鈣血症（流程圖 1）：
●症狀（例如手足痙攣、喉痙攣、支氣管痙攣、癲癇發作）
●QT間期延長
Severe symptomatic and/or acute hypocalcemia — We recommend intravenous (IV) calcium for the treatment of hypocalcemia in patients with (algorithm 1):
●Symptoms (eg, carpopedal spasm, laryngospasm, bronchospasm, seizures)●A prolonged QT interval
or
●血清校正鈣急劇下降至≤7.5 mg/dL（≤1.9 mmol/L）的無症狀患者，如果不治療可能會出現嚴重並發症。在離子鈣測定中，正常範圍為 4.8 至 5.6 mg/dL（1.2 至 1.4 mmol/L），閾值約為 ≤3 mg/dL（≤0.8 mmol/L）。當血清鈣快速、進行性降低時，可能會發生急性低鈣血症（例如，頭頸癌根治性頸清掃術後出現急性甲狀旁腺功能減退症）。
●In asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL (≤1.9 mmol/L), who may develop serious complications if untreated. In an ionized calcium assay with a normal range of 4.8 to 5.6 mg/dL (1.2 to 1.4 mmol/L), the threshold is approximately ≤3 mg/dL (≤0.8 mmol/L). Acute hypocalcemia can occur when there is a rapid and progressive reduction in serum calcium (eg, acute hypoparathyroidism following radical neck dissection for head and neck cancer).
●In asymptomatic patients with an acute decrease in serum corrected calcium to ≤7.5 mg/dL (≤1.9 mmol/L), who may develop serious complications if untreated. In an ionized calcium assay with a normal range of 4.8 to 5.6 mg/dL (1.2 to 1.4 mmol/L), the threshold is approximately ≤3 mg/dL (≤0.8 mmol/L). Acute hypocalcemia can occur when there is a rapid and progressive reduction in serum calcium (eg, acute hypoparathyroidism following radical neck dissection for head and neck cancer).
應密切監測接受地高辛治療的患者，最好通過遙測技術監測急性洋地黃毒性，這種毒性可因靜脈輸注鈣劑而發生。然而，一項對 23 名患者的回顧性圖表審查發現，靜脈注射鈣不會導致地高辛中毒患者出現惡性心律失常或死亡率增加 [ 4 ]。
Patients receiving digoxin should be monitored closely, preferably with telemetry, for acute digitalis toxicity, which can develop with IV calcium infusion. However, one retrospective chart review of 23 patients found that IV calcium did not cause malignant dysrhythmias or increased mortality in digoxin-intoxicated patients [4].
對於無症狀或患有慢性穩定低鈣血症且僅有輕微症狀（例如感覺異常）的慢性腎病患者，不建議將靜脈鈣作為初始治療。對於慢性腎病患者，糾正高磷血症和低循環 1,25-二羥基維生素 D 通常是首要目標。(參見 “成人慢性腎髒病患者高磷血症的治療”和 “成人透析患者繼發性甲狀旁腺功能亢進症的治療”和 “成人非透析慢性腎髒病患者繼發性甲狀旁腺功能亢進症的治療” )
IV calcium is not warranted as initial therapy in patients with chronic kidney disease who are asymptomatic or who have chronic stable hypocalcemia with only mild symptoms (eg, paresthesias). In patients with chronic kidney disease, correction of hyperphosphatemia and of low circulating 1,25-dihydroxyvitamin D are usually the primary goals. (See "Management of hyperphosphatemia in adults with chronic kidney disease" and "Management of secondary hyperparathyroidism in adult dialysis patients" and "Management of secondary hyperparathyroidism in adult nondialysis patients with chronic kidney disease".)
靜脈鈣給藥 — 最初，可以在 10 至 20 分鐘內輸注靜脈鈣（1 或 2 g葡萄糖酸鈣，相當於 90 或 180 mg 元素鈣，溶於 50 mL 5% 葡萄糖或生理鹽水） 。如果需要緩解症狀，可在 10 至 60 分鐘後重複推注。不應更快地給予鈣，因為存在嚴重心功能障礙的風險，包括收縮期驟停[ 5 ]。推注葡萄糖酸鈣只會使血清鈣濃度升高兩到三個小時；因此，對於持續性低鈣血症患者，應緩慢輸注鈣。
Intravenous calcium dosing — Initially, IV calcium (1 or 2 g of calcium gluconate, equivalent to 90 or 180 mg elemental calcium, in 50 mL of 5% dextrose or normal saline) can be infused over 10 to 20 minutes. The bolus may be repeated after 10 to 60 minutes, if needed to resolve symptoms. The calcium should not be given more rapidly, because of the risk of serious cardiac dysfunction, including systolic arrest [5]. The bolus dose of calcium gluconate will raise the serum calcium concentration for only two or three hours; as a result, it should be followed by a slow infusion of calcium in patients with persistent hypocalcemia.
可以使用10%葡萄糖酸鈣溶液（每 10 mL 含有 90 mg 元素鈣）來製備連續輸注。葡萄糖酸鈣優於氯化鈣，因為如果外滲，它不太可能導致組織壞死。如果沒有葡萄糖酸鈣，可以使用 10% 氯化鈣溶液（每 10 毫升含 270 毫克元素鈣）作為替代方案。
A solution of 10% calcium gluconate (90 mg of elemental calcium per 10 mL) can be used to prepare the continuous infusion. Calcium gluconate is preferred to calcium chloride because it is less likely to cause tissue necrosis if extravasated. A solution of 10% calcium chloride (270 mg of elemental calcium per 10 mL) is an alternative if calcium gluconate is unavailable.
將 11 g 葡萄糖酸鈣（相當於 1000 mg 元素鈣）添加到生理鹽水或5% 葡萄糖水中以提供 1000 mL 的最終體積，製備含有 1 mg/mL 元素鈣的 IV 溶液。該溶液的初始輸注速度為 50 mL/小時（相當於 50 mg 元素鈣/小時）。可以調整劑量以將血清鈣濃度維持在正常範圍的下限（如上所述根據血清白蛋白的任何異常校正血清鈣）。患者通常每小時需要 0.5 至 1.5 毫克/公斤的元素鈣。
An IV solution containing 1 mg/mL of elemental calcium is prepared by adding 11 g of calcium gluconate (equivalent to 1000 mg elemental calcium) to normal saline or 5% dextrose water to provide a final volume of 1000 mL. This solution is administered at an initial infusion rate of 50 mL/hour (equivalent to 50 mg elemental calcium/hour). The dose can be adjusted to maintain the serum calcium concentration at the lower end of the normal range (with the serum calcium corrected for any abnormalities in serum albumin as noted above). Patients typically require 0.5 to 1.5 mg/kg of elemental calcium per hour.
準備輸液時應考慮以下因素：
●鈣應在葡萄糖和水或鹽水中稀釋，因為濃鈣溶液會刺激靜脈。
The infusion should be prepared with the following considerations:
●The calcium should be diluted in dextrose and water or saline because concentrated calcium solutions are irritating to veins.
●靜脈注射溶液不應含有碳酸氫鹽或磷酸鹽，它們會形成不溶性鈣鹽。如果需要這些陰離子，應使用另一條靜脈輸液管（在另一肢）。
●The IV solution should not contain bicarbonate or phosphate, which can form insoluble calcium salts. If these anions are needed, another IV line (in another limb) should be used.
應繼續靜脈補鈣，直至患者接受口服鈣和維生素 D 的有效治療方案。對於急性甲狀旁腺功能減退症患者，可使用骨化三醇（劑量為0.25至0.5 微克，每日兩次）和口服鈣（1 至4 克元素鈣）應盡快開始服用（每天分次服用）。骨化三醇是嚴重急性低鈣血症患者的首選維生素 D 製劑，因為其起效快（數小時）。急性和慢性甲狀旁腺功能減退症的治療詳見其他專題。
IV calcium should be continued until the patient is receiving an effective regimen of oral calcium and vitamin D. For patients with acute hypoparathyroidism, calcitriol (in a dose of 0.25 to 0.5 mcg twice daily) and oral calcium (1 to 4 g of elemental calcium carbonate daily in divided doses) should be initiated as soon as possible. Calcitriol is the preferred preparation of vitamin D for patients with severe acute hypocalcemia because of its rapid onset of action (hours). The management of acute and chronic hypoparathyroidism are reviewed in more detail separately.
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