Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care
Thyroidectomy Calcium Management Clinical Pathway — Inpatient and Outpatient Specialty Care
Calcium Carbonate Dosing
General Information
- Epic Ordering:
- Based on mg of elemental calcium (Ca++)
- 1 g calcium carbonate = 400 mg of elemental calcium (40% of prescribed dose)
- Asymptomatic children
- Begin at lower dose of the range
- Titration
- Titrate the calcium and/or calcitriol if there is no improvement in calcium level
Tips for Administration
- Take calcium with food or milk to maximize absorption; avoid bran, foods high in oxalates or whole grain cereals which may decrease calcium absorption
- Separate calcium from levothyroxine or liothyronine; ideally 1-4 hrs when possible
- Children rarely require > 3 times daily dosing after discharge
Dosing example, use tables below
- An asymptomatic 5-year-old female (weight 20 kg) should be started on 250 mg of elemental calcium three times a day. This dose is the equivalent of 625 mg of calcium carbonate. She should receive the oral suspension 2.5 ml three times a day.
| Weight, kg | Dose, mg Elemental Ca++ |
|---|---|
| < 30 | 250-500 mg 3 times daily |
| > 30 | 500 mg 3 times daily |
CHOP Inpatient Pharmacy Options
| Formulation | Elemental Ca++ | Calcium Carbonate (Salt, mg) |
|---|---|---|
| Oral Suspension | 500 mg/5mL | 1250 mg/5mL |
| Calcium Carbonate Chewable Tablets | 200 mg | 500 mg |
| Calcium Carbonate Tablets | 500 mg | 1250 mg |
Calcium Carbonate, OTC – Tums or Generic Equivalent
| Formulation | Elemental Ca++ | Calcium Carbonate (Salt, mg) |
|---|---|---|
| Tums Regular | 200 mg | 500 mg |
| Tums Extra Strength | 300 mg | 750 mg |
| Tums Ultra Strength | 400 mg | 1000 mg |