How should I manage a patient with hypoparathyroidism who presents with symptomatic hypocalcemia?

Management of a patient with hypoparathyroidism presenting with symptomatic hypocalcaemia involves urgent correction of the low calcium levels to relieve symptoms and prevent complications.

• Initial treatment: Administer intravenous calcium gluconate cautiously to rapidly correct symptomatic hypocalcaemia, especially if symptoms are severe (e.g., tetany, seizures, cardiac arrhythmias).
• Maintenance therapy: After acute correction, start oral calcium supplements and active vitamin D analogues (such as calcitriol) to maintain serum calcium within the low-normal range and prevent recurrence of symptoms.
• Monitoring: Regularly monitor serum calcium, phosphate, and renal function to avoid hypercalcaemia and hypercalciuria, which can cause renal complications.
• Specialist referral: Refer to an endocrinologist for ongoing management and adjustment of therapy.

Note: Although the provided guidelines focus primarily on hyperparathyroidism and hypercalcaemia, the principles of managing symptomatic hypocalcaemia in hypoparathyroidism are well established in clinical practice and involve urgent calcium replacement and maintenance with calcium and active vitamin D analogues to compensate for deficient parathyroid hormone.