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# Calcium Acetate ## Overview Calcium acetate is a phosphate binder used to reduce serum phosphate levels in patients with hyperphosphatemia, commonly seen in chronic kidney disease (CKD). It binds to dietary phosphate in the gastrointestinal tract, forming insoluble calcium phosphate which is then excreted. ## Primary Indications * Treatment of hyperphosphatemia in patients with end-stage renal disease (ESRD). ## Adult Dosing Dose is individualized based on serum phosphate levels. * **Initial dose:** 667 mg (equivalent to 13.3 mEq elemental calcium) administered orally with meals. * **Titration:** Dose should be adjusted to maintain serum phosphate levels below 6 mg/dL. Typical doses range from 667 mg to 1334 mg (13.3 to 26.7 mEq calcium) with each meal. * **Maximum dose:** Typically not to exceed 4000 mg (80 mEq calcium) per day. Some sources suggest a maximum of 3000 mg per day. Always refer to specific institutional guidelines. ## Pediatric Dosing Dosing in pediatric patients is not well-established and should be individualized under expert guidance. Some sources suggest an initial dose of 10-13 mg/kg/day of elemental calcium divided into 3 doses with meals. This equates to approximately 200-300 mg of calcium acetate per dose for a 50 kg child. ## Dose Adjustments * **Renal Impairment:** Dose must be carefully titrated based on serum phosphate and calcium levels. Caution is advised due to risk of hypercalcemia. ## Contraindications * Hypercalcemia. * Hypersensitivity to calcium acetate. * Anasarca. * Concurrent use with sorbitol. ## Adverse Effects * **Common:** Hypercalcemia (most significant), constipation, nausea, vomiting, abdominal pain. * **Serious:** Vascular calcification, cardiac complications. ## Key Drug Interactions * **Sorbitol:** Concurrent use increases the risk of metabolic acidosis and dehydration. Avoid. * **Tetracyclines, Quinolones, Bisphosphonates, Thyroid Hormones:** Calcium acetate can decrease the absorption of these drugs by forming chelates. Administer at least 2 hours before or 4-6 hours after these medications. * **Thiazide Diuretics:** May increase the risk of hypercalcemia. * **Vitamin D:** May enhance the absorption of calcium and increase the risk of hypercalcemia. ## Monitoring * **Serum Phosphate:** Regularly monitor to guide dosing and assess efficacy. * **Serum Calcium:** Regularly monitor to prevent and detect hypercalcemia. Target serum calcium levels are typically 8.4 to 9.5 mg/dL. * **Alkaline Phosphatase:** Monitor for potential signs of bone disease. * **Fluid and Electrolyte Balance:** Especially in patients with CKD. ## Clinical Pearls * Administer with meals to ensure adequate binding of dietary phosphate. * Monitor serum calcium and phosphate levels closely, especially during initiation and dose adjustments. * Educate patients on signs and symptoms of hypercalcemia (e.g., nausea, vomiting, constipation, polyuria, fatigue, confusion, cardiac arrhythmias). * Consider alternative phosphate binders if hypercalcemia is persistent. *** **Disclaimer:** This information is intended for healthcare professionals. It is essential to consult the most current prescribing information and institutional protocols before administering any medication. Dosing and management may vary based on individual patient factors and clinical context.