What is the first choice of treatment for symptomatic hypocalcemia?

The first choice of treatment for symptomatic hypocalcemia is calcium gluconate administered intravenously. This approach is preferred because symptomatic hypocalcemia can present with severe clinical manifestations such as muscle twitching, seizures, or cardiac arrhythmias that require rapid correction. IV calcium gluconate acts quickly to raise calcium levels in the blood, providing immediate relief from the symptoms and preventing potential complications related to low calcium levels.

Oral calcium supplements may be appropriate for asymptomatic hypocalcemia or for long-term management, but they do not provide the rapid response needed in acute situations. Intramuscular calcium injections are less commonly used than IV administration, as they are not as effective for immediate treatment and can be associated with local tissue irritation. Monitoring without intervention may be suitable in cases where hypocalcemia is not symptomatic or where the patient is stable; however, this would not be the approach for a patient showing symptoms, where prompt treatment is essential.