When should I consider referring a patient with hypocalcaemia to secondary care for further evaluation?

Consider referring a patient with hypocalcaemia to secondary care for further evaluation if:

• They are already taking calcium supplements but hypocalcaemia persists, indicating the need for specialist assessment.
• There is an inadequate response to initial treatment for vitamin D deficiency or hypocalcaemia, warranting further investigation.
• There is suspicion of an alternative diagnosis beyond simple vitamin D deficiency or nutritional causes.
• The clinical picture is complex or severe, or if the cause of hypocalcaemia is unclear after initial primary care assessment.

Referral allows for specialist investigations, including detailed biochemical testing and management planning.

In summary, referral is appropriate when hypocalcaemia is persistent despite treatment, when the diagnosis is uncertain, or when specialist input is needed for complex cases.

References: These recommendations are based on the extrapolated guidance for managing hypocalcaemia and vitamin D deficiency, which advise referral if there is ongoing hypocalcaemia despite supplementation or if further investigation is required ².