Version May 2024
| Postoperative day | Serum tests | Therapy |
| Night of surgery | Calcium in the evening (approximately 8 PM) | Ca <7.5 mg/dL: Calcitriol 0.5 mcg three times daily x three days and calcium gluconate 3 g/L D5 1/2 normal saline IV at 100 mL/hour |
| Day 1 | Calcium and phosphorus in the morning (approximately 6 AM); if Ca <7.5 mg/dL, add magnesium | Ca <7.5 mg/dL: Calcitriol 0.5 mcg twice daily x three days and adjust depending upon calcium response and calcium gluconate 3 g/L D5 1/2 normal saline IV at 100 mL/hour and calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses depending upon calcium response Ca 7.5 to 8.0 mg/dL: Calcitriol 0.5 mcg twice daily x three days and adjust depending upon calcium response and calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses depending upon calcium response Ca >8.0 mg/dL: Calcium carbonate (1 g elemental calcium) by mouth twice daily Mg <2 mg/dL: Magnesium sulfate 4 g in 100 mL normal saline IV at 33 mL/hour and magnesium oxide 400 mg by mouth twice daily x one month |
| Day 2 to 4 | If day 1 Ca ≤8.0 mg/dL, total calcium and phosphorus | Ca <7.5 mg/dL and symptomatic: Calcitriol 0.25 mcg three times daily and calcium gluconate 3 g/L D5 1/2 normal saline IV at 100 mL/hour and calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses and modify based upon calcium response Ca <7.5 mg/dL and asymptomatic: Calcitriol 0.25 mcg three times daily and calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses and modify based upon calcium response Ca 7.5 to 8.4 mg/dL or P ≥4.5 mg/dL: Calcitriol 0.25 mcg daily and calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses and modify based upon calcium response Ca 8.5 to 9.4 mg/dL and P ≤4.5 mg/dL: Calcium carbonate (1 to 4 g elemental calcium) by mouth daily in divided doses and modify based upon calcium response Ca ≥9.5 mg/dL: No therapy |
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