No

Antidote; Calcium Salt; Electrolyte Supplement, Oral

Oral: Control of hyperphosphatemia in end-stage renal failure; calcium acetate binds to phosphorus in the GI tract better than other calcium salts due to its lower solubility and subsequent reduced absorption and increased formation of calcium phosphate; calcium acetate does not promote aluminum absorption

I.V.: Calcium supplementation in parenteral nutrition therapy

C

Hypercalcemia, renal calculi, hypophosphatemia

Calcium absorption is impaired in achlorhydria (common in elderly - try alternate salt, administer with food); administration is followed by increased gastric acid secretion within 2 hours of administration; while hypercalcemia and hypercalciuria may result when therapeutic replacement amounts are given for prolonged periods, they are most likely to occur in hypoparathyroid patients receiving high doses of vitamin D

Mild hypercalcemia (calcium: >10.5 mg/dL) may be asymptomatic or manifest itself as constipation, anorexia, nausea, and vomiting

More severe hypercalcemia (calcium: >12 mg/dL) is associated with confusion, delirium, stupor, and coma

<1%: Headache, hypophosphatemia, hypercalcemia, nausea, anorexia, vomiting, abdominal pain, constipation, thirst

Acute single ingestions of calcium salts may produce mild gastrointestinal distress, but hypercalcemia or other toxic manifestations are extremely unlikely

Treatment is supportive

Decreased effect:

Calcium acetate may significantly decrease the bioavailability of tetracyclines

Large intakes of dietary fiber may decrease calcium absorption due to a decreased GI transit time and the formation of fiber-calcium complexes

Increased effect: Calcium acetate may increase the effects of quinidine

Admixture incompatibilities: Carbonates, phosphates, sulfates, tartrates

Combines with dietary phosphate to form insoluble calcium phosphate which is excreted in feces

Absorption: From the GI tract requires vitamin D; minimal absorption unless chronic, high doses are given; calcium is absorbed in soluble, ionized form; solubility of calcium is increased in an acid environment

Distribution: Crosses the placenta; appears in breast milk

Elimination: Mainly in feces as unabsorbed calcium with 20% eliminated by the kidneys

Oral: Adults, on dialysis: Initial: 2 tablets with each meal, can be increased gradually to 3-4 tablets with each meal to bring the serum phosphate value <6 mg/dL as long as hypercalcemia does not develop

I.V.: Dose is dependent on the requirements of the individual patient; in central venous total parental nutrition (TPN), calcium is administered at a concentration of 5 mEq (10 mL)/L of TPN solution; the additive maintenance dose in neonatal TPN is 0.5 mEq calcium/kg/day (1.0 mL/kg/day)

Neonates: 70-200 mg/kg/day

Infants and Children: 70-150 mg/kg/day

Adolescents: 18-35 mg/kg/day

Tablets must be administered with meals to be effective

Serum calcium: 8.4-10.2 mg/dL

Due to a poor correlation between the serum ionized calcium (free) and total serum calcium, particularly in states of low albumin or acid/base imbalances, direct measurement of ionized calcium is recommended

In low albumin states, the corrected total serum calcium may be estimated by this equation (assuming a normal albumin of 4 g/dL)

Corrected total calcium = total serum calcium + 0.8 (4.0 - measured serum albumin)

or

Corrected calcium = measured calcium - measured albumin + 4.0

calcium (S); magnesium

May cause confusion and delirium (as a consequence of hypercalcemia)

None reported

No information available to require special precautions

No effects or complications reported

Can take with food; do not take calcium supplements within 1-2 hours of taking other medicine by mouth or eating large amounts of fiber-rich foods; do not use nonprescription antacids or drink large amounts of alcohol, caffeine-containing beverages, or use tobacco

12.7 mEq/g; 250 mg/g elemental calcium (25% elemental calcium)

Elemental calcium listed in brackets

Injection, 0.5 mEq calcium/mL (39.55 mg calcium acetate/mL) 10 mL vial

Tablet:

Calphron®: 667 mg [169 mg]

PhosLo®: 667 mg [169 mg]

Kaiser W, Biesenbach G, Kramar R, et al, "Calcium Free Hemodialysis: An Effective Therapy in Hypercalcemic Crisis - Report of Four Cases," Intensive Care Med, 1989, 15(7):471-4.

Texier D, Chevallier P, Perrotin D, et al, "Hypercalcemia Associated With Resorbable Haemostatic Compresses," Lancet, 1982, 1(8273):688-9.