Parenteral calcium for intensive care unit patients

Several epidemiological studies of critically ill patients highlight a direct association between low levels of calcium (hypocalcemia) and mortality, though whether this association is causal is unknown. On the other hand, despite prior studies detailing associations between hypocalcemia and poor outcome, there is evidence to suggest that calcium supplementation in critical illness may be deleterious. Five randomized controlled trials with 159 participants were detected. All of the five included studies were conducted in the USA. No trial evaluated the association between parenteral calcium supplementation in critically ill intensive care unit patients and the following outcomes: mortality, multiple organ dysfunction, intensive care unit and hospital length of stay, costs, and complications of calcium administration. Some data on laboratory measurements (serum calcium) could be extracted. Nonetheless, these data provide little to guide the care of intensive care unit patients. The question of greater importance, "Does correcting hypocalcemia in critically ill patients provide any benefit in reducing mortality, the development of organ dysfunction, or the allocation of resources ?" remains to be answered. At present, the evidence base for guidelines regarding calcium administration in intensive care unit patients is poor.