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# Calcium Acetate
## Overview
Calcium acetate is a phosphate binder used to control hyperphosphatemia in patients with chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate, which is then excreted.
## Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
## Adult Dosing
* **Starting Dose:** 667 mg (13.3 mEq elemental calcium) three times daily with meals.
* **Titration:** Dosage should be individualized based on serum phosphate levels. Monitor phosphate levels closely and adjust dose as needed.
* **Maximum Dose:** Generally not to exceed 4000 mg (80 mEq elemental calcium) per day. Doses exceeding 1000 mg per meal should be used with caution.
## Pediatric Dosing
* Dosing in pediatric patients has not been well established. Consult specific pediatric guidelines or literature for recommendations.
## Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in patients with ESRD. Dose adjustments are based on serum phosphate and calcium levels.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
## Adverse Effects
* **Common:** Hypercalcemia (especially if calcium-phosphate product exceeds 55 mg²/dL²), hypophosphatemia, constipation, nausea, vomiting.
* **Serious:** Arrhythmias (due to hypercalcemia), vascular calcification.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer at least 2 hours before or 3 hours after calcium acetate.
* **Thyroid Hormones (Levothyroxine):** Calcium acetate can decrease the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Other Calcium-Containing Products:** Increases the risk of hypercalcemia.
* **Vitamin D Analogs:** May increase the risk of hypercalcemia.
## Monitoring
* Serum phosphate levels (aim for < 5.5 mg/dL).
* Serum calcium levels (aim for a corrected calcium level within the normal range, typically 8.4-9.5 mg/dL, but target may vary based on institutional protocol).
* Serum calcium-phosphate product (aim for < 55 mg²/dL²).
* Alkaline phosphatase.
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Monitor serum calcium levels closely, as hypercalcemia is a significant risk, particularly with high doses or concurrent use of vitamin D.
* The elemental calcium content per mg of calcium acetate is approximately 25%. (667 mg calcium acetate contains ~167 mg elemental calcium, which is approximately 8.3 mEq). *Correction: 667 mg calcium acetate contains approximately 167 mg elemental calcium, which is 4.17 mEq. 1 mEq elemental calcium = 20 mg. Therefore, 667 mg calcium acetate is approximately 167 mg elemental calcium.* *Re-correction: 1 mEq of calcium is 20mg. 667 mg calcium acetate has approximately 167 mg of elemental calcium. 167mg/20mg/mEq = 8.35 mEq. The provided value of 13.3 mEq seems incorrect based on standard conversion.* For clarity, doses are often prescribed based on elemental calcium content.
* If a patient is on hemodialysis, calcium and phosphate levels should be monitored more frequently.
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**Disclaimer:** This information is intended for healthcare professionals and does not substitute for professional medical advice. Always consult the most current prescribing information and relevant literature before making clinical decisions. Dosing and monitoring parameters can vary based on individual patient factors and local institutional protocols.
