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 to investigate underlying causes and adjust treatment.
• 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, requiring specialist input.
• The clinical picture is complex or severe, or if the patient has features suggestive of primary or secondary causes that need specialist diagnostic testing and management.

In primary care, initial management includes assessing vitamin D status and starting supplementation if needed, but referral is advised when treatment response is inadequate or when the diagnosis is unclear or complicated.

These recommendations are based on good clinical practice extrapolated from the ROS guideline and expert opinion, as there are no specific primary care hypocalcaemia referral guidelines.

Therefore, referral should be considered when hypocalcaemia is persistent despite treatment, when the patient is already on calcium supplements, or when the diagnosis is uncertain or complex.

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