During total thyroidectomy for papillary carcinoma, bilateral parathyroid galand can be preserved. Ten milliliters of 10% solution (1 g) of calcium gluconate may be administered over 10 minutes. 10ml10% calcium gluconate ivi q8h. A calcium infusion may be started at a rate of 1-2 mg/kg/h if symptoms do not resolve. Titrate the infusion to the patient’s symptoms and calcium levels. Start oral calcium when the patient is able to tolerate it. One to two grams of elemental oral calcium should be supplied each day. Calcium carbonate 1250 mg provides 500 mg of elemental calcium; therefore, the patient should take 2500-5000 mg/day. The patient needs concomitant replacement of vitamin D with calcitriol (Rocaltrol) 0.25-1 mcg/d.
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