Please check your internet connection and try again.
## Calcium Acetate
### Overview
Calcium acetate is a phosphate binder used to manage hyperphosphatemia in patients with chronic kidney disease (CKD).
### Primary Indications
* Hyperphosphatemia in patients with end-stage renal disease (ESRD).
### Adult Dosing
* **Dosing is individualized based on serum phosphate levels.**
* Administer with meals.
* Initial dose: 667 mg (equivalent to 169 mg elemental calcium) orally three times daily with meals.
* Titrate dose every 2-4 weeks based on serum phosphate levels.
* Target serum phosphate level: < 6.0 mg/dL.
* Typical maintenance dose: 1333 mg to 2000 mg orally three times daily with meals.
* Maximum dose: Typically not to exceed 4000 mg per day, although higher doses may be used under strict monitoring.
### Pediatric Dosing
* There is limited established pediatric dosing. Dosing should be individualized and carefully monitored.
* Some sources suggest starting doses of 5-10 mg/kg/day of elemental calcium (approximately 20-40 mg/kg/day of calcium acetate) divided into 3 doses with meals. Further titration is based on serum phosphate.
### Dose Adjustments
* **Renal Impairment:** Not applicable as it is used in ESRD patients. Monitor calcium and phosphate levels closely.
* **Hepatic Impairment:** No specific dose adjustments are usually necessary.
### Contraindications
* Hypercalcemia.
* Hypersensitivity to calcium acetate.
* Anuria or oliguria (risk of hypercalcemia).
### Adverse Effects
* **Hypercalcemia:** Most common. Symptoms include constipation, nausea, vomiting, abdominal pain, dry mouth, thirst, polyuria, confusion, fatigue, lethargy, muscle weakness, and cardiac arrhythmias.
* Gastrointestinal: Nausea, vomiting, constipation, diarrhea, dyspepsia.
* Other: Headache, rash.
### Key Drug Interactions
* **Tetracyclines and Fluoroquinolones:** Calcium acetate can decrease the absorption of these antibiotics. Administer them at least 1 hour before or 3 hours after calcium acetate.
* **Thyroid Hormones:** Calcium acetate can reduce the absorption of thyroid hormones. Separate administration by at least 4 hours.
* **Digoxin:** Hypercalcemia may increase the risk of digoxin toxicity.
* **Thiazide Diuretics:** Can increase the risk of hypercalcemia.
### Monitoring
* Serum calcium (corrected for albumin).
* Serum phosphate.
* Alkaline phosphatase.
* BUN and creatinine.
* Symptoms of hypercalcemia.
* Monitor calcium-x-phosphate product to minimize risk of metastatic calcification.
### Clinical Pearls
* Administer calcium acetate with meals to effectively bind dietary phosphate.
* Correct calcium levels for albumin when interpreting serum calcium. Corrected calcium = Measured calcium + 0.8 * (4.0 - Measured albumin).
* If hypercalcemia occurs, reduce or temporarily discontinue calcium acetate and decrease dietary calcium and vitamin D intake.
***
*Disclaimer: This information is intended for healthcare professionals. Always consult the most current prescribing information and institutional protocols before administering any medication.*
