How should I monitor patients with chronic hypocalcaemia to ensure effective management and prevent complications?

Monitoring patients with chronic hypocalcaemia involves regular clinical and biochemical assessment to ensure effective management and prevent complications.

• Serum calcium levels should be regularly checked to maintain calcium within the target range and detect any fluctuations early.
• Serum 25-hydroxyvitamin D (25[OH]D) levels may be checked 3–6 months after starting vitamin D treatment in certain groups to assess response and adherence, but routine frequent monitoring is not generally required.
• Assess adherence to vitamin D and calcium therapy and consider further investigation if there is an inadequate response to treatment.
• Advise patients on lifestyle measures such as adequate oral calcium intake and vitamin D supplementation to prevent recurrent deficiency.
• Monitor for symptoms of hypocalcaemia or complications related to chronic low calcium levels, including neuromuscular irritability or cardiac issues.
• Consider referral to specialist care if patients are already on calcium supplements but have persistent hypocalcaemia or complications.

These recommendations are based on the management principles extrapolated from vitamin D deficiency guidelines and expert opinion, as specific UK primary care guidelines for chronic hypocalcaemia monitoring are limited ².