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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
The initial dose is typically 2 tablets (approximately 133 mg elemental calcium per tablet) with each meal. Dosing should be individualized based on serum phosphate levels. The target serum phosphate level is generally less than 6 mg/dL.
Maximum recommended dose is typically 16 tablets (approximately 2128 mg elemental calcium) per day, divided with meals. However, doses may be higher based on individual patient response and tolerance, keeping in mind the risk of hypercalcemia.
## Pediatric Dosing
The use of calcium acetate in pediatric patients is not well-established. Dosing should be individualized and guided by expert consultation, considering age, weight, and serum phosphate levels.
## Dose Adjustments
* **Hypercalcemia:** Reduce dose or temporarily discontinue therapy.
* **Hypocalcemia:** Increase dose.
* **Renal Impairment:** Dose adjustment may be necessary, particularly in patients not on dialysis, to avoid calcium accumulation.
## Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Concurrent use with intravenous calcium.
## Adverse Effects
The most common adverse effects are related to hypercalcemia, including:
* Nausea, vomiting, constipation
* Hypercalcemia symptoms: lethargy, confusion, anorexia, polyuria, polydipsia, dehydration, cardiac arrhythmias.
* Sevelamer or lanthanum carbonate may be preferred if hypercalcemia is a significant concern.
## Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Separate administration by at least 2 hours.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of levothyroxine. Separate administration by at least 4 hours.
* **Cation-Donating Medications:** Concurrent use of other calcium salts or antacids containing calcium may increase the risk of hypercalcemia.
* **Digoxin:** Hypercalcemia can increase the risk of digoxin toxicity.
## Monitoring
* Serum calcium levels (frequently, especially during dose initiation or adjustment).
* Serum phosphate levels.
* Alkaline phosphatase.
* Urine calcium excretion (in non-dialysis patients).
## Clinical Pearls
* Administer with meals to maximize phosphate binding.
* Patients should be educated on symptoms of hypercalcemia.
* Consider the total calcium load from all sources (diet, supplements, medications).
* For patients on hemodialysis, serum calcium levels should be corrected for serum albumin.
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*This information is intended for healthcare professionals. It is essential to consult the current prescribing information and institutional guidelines for complete and up-to-date details.*
