In a patient with symptomatic hypoparathyroidism causing severe hypocalcemia, which immediate therapy is indicated?

In a patient with symptomatic hypoparathyroidism causing severe hypocalcemia, which immediate therapy is indicated?

• A. Oral calcium carbonate
• B. Magnesium sulfate
• C. Levothyroxine
• D. IV calcium gluconate

Answer: (D)

In acute, symptomatic hypocalcemia from hypoparathyroidism, the priority is to restore extracellular calcium quickly to prevent dangerous neuromuscular and cardiac complications. Intravenous calcium gluconate delivers calcium into the bloodstream rapidly, making it the most appropriate immediate therapy. Oral calcium cannot correct severe hypocalcemia quickly enough to avert symptoms like tetany, seizures, or arrhythmias. Magnesium sulfate is considered if there is concurrent hypomagnesemia, since low Mg can worsen hypocalcemia, but it does not replace the need for IV calcium in an acute crisis. Levothyroxine has no role in correcting calcium abnormalities. After stabilization, long-term management involves calcium supplementation and active vitamin D, but the immediate step is IV calcium gluconate to raise calcium promptly.

In acute, symptomatic hypocalcemia from hypoparathyroidism, the priority is to restore extracellular calcium quickly to prevent dangerous neuromuscular and cardiac complications. Intravenous calcium gluconate delivers calcium into the bloodstream rapidly, making it the most appropriate immediate therapy. Oral calcium cannot correct severe hypocalcemia quickly enough to avert symptoms like tetany, seizures, or arrhythmias.

Magnesium sulfate is considered if there is concurrent hypomagnesemia, since low Mg can worsen hypocalcemia, but it does not replace the need for IV calcium in an acute crisis. Levothyroxine has no role in correcting calcium abnormalities. After stabilization, long-term management involves calcium supplementation and active vitamin D, but the immediate step is IV calcium gluconate to raise calcium promptly.