How should I monitor and manage a patient with chronic hypocalcaemia in a primary care setting?

Monitoring and managing chronic hypocalcaemia in primary care:

• Confirm the diagnosis by measuring serum calcium and consider checking serum 25-hydroxyvitamin D levels to identify vitamin D deficiency as a common cause of hypocalcaemia.
• Initiate treatment with calcium supplements and vitamin D analogues as appropriate, ensuring patient adherence and monitoring for clinical response.
• Routine monitoring of serum 25-hydroxyvitamin D after a fixed loading regimen is not usually required; however, consider rechecking levels 3–6 months after starting treatment in certain groups to assess adequacy of therapy.
• Assess and advise on lifestyle measures to support calcium and vitamin D status, including diet and safe sunlight exposure.
• If hypocalcaemia persists despite supplementation, or if the patient is already on calcium supplements without improvement, arrange referral to a specialist for further evaluation.
• Monitor serum calcium regularly to ensure levels are maintained within the normal range and to detect any complications.

Summary: In primary care, management focuses on confirming diagnosis, correcting vitamin D deficiency, supplementing calcium, monitoring biochemical response, supporting lifestyle measures, and referring to specialists if treatment is inadequate or the cause is unclear ².