Hypocalcemia in the Critical Care Setting: from its clinical relevance to its treatment

Abstract

Hypocalcemia is a common derangement in critically ill patients. Hypocalcemia tends to be corrected as a routine procedure in Intensive Care Units, however there are no clear guidelines on how it should be managed. The goal of this review is to do an overview of hypocalcemia in the critical care setting, from its association with important clinical outcomes to the assessment of the need for its correction in critical patients in general, as well as in two specific subgroups: trauma and septic patients. Several studies show an association between hypocalcemia and higher mortality, as well as an increased risk of disease severity in critical patients. The majority of studies show that calcium supplementation does not improve clinical outcomes and that, in some cases, it can lead to deleterious consequences in critical patients. Trauma and septic patients are two specific subgroups of the critical patients' population, with special characteristics that should be taken into consideration when treating hypocalcemia. We conclude that there is an association between low levels of ionized calcium and several important clinical outcomes. The scientific evidence regarding the correction of hypocalcemia is still very conflictual. In terms of severe hypocalcemia, the collective opinion is that it should be treated. However, there is a need for a larger multicenter clinical trial to assess the efficacy and safety of treating hypocalcemia in these patients.