22q11.2 ERAS: Discharge Recommendations

• For children who had calcium values less than 8 mg/dL or ionized calcium less than 1.1 mmol/L following the procedure, continue the same dose of calcium and Calcitriol (if needed) at discharge. 

Educate family on signs of hypocalcemia: 

• Signs of hypocalcemia include peri-oral numbness, tingling/prickling of the hands or feet, muscle cramps and/or spasms (especially during measurement of blood pressure), stridor or laryngospasm (dysphagia or change in voice), or seizure.
• Symptoms of hypocalcemia include fatigue, hyperirritability, anxiety, and depression.

Laboratory studies: 

• Patients who required treatment during or post-procedure and were discharged should have calcium measured as an outpatient 2 - 3 days after procedure. 

• Anesthesiologist will order calcium lab and route to (and notify) primary Endocrinologist 

• Instruct child/caregiver to notify Endocrinologist of signs/symptoms of hypocalcemia and repeat labs sooner. 

Follow-up recommendations: 

• If treatment for hypocalcemia is required during procedure/admission, schedule follow-up with Endocrinologist within 3 months.

These pathways do not establish a standard of care to be followed in every case. It is recognized that each case is different, and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare a pathway for each. Accordingly, these pathways should guide care with the understanding that departures from them may be required at times.