Calcium Salts
Synonyms :
Calcium Carbonate, Calcium Chloride, Calcium Gluconate, Calcium Phosphate
Mechanism :
Calcium is a mineral essential for cardiac function, muscle contraction, coagulation of blood and for maintaining structural integrity of cell membranes. It is one of the constituents of hydroxyapatite and is the main constituent of the bones and teeth. Calcium salts are used as nutritional supplements and are recommended for growing children. It is available as calcium salts in the form of calcium glubionate (Elemental calcium = 23 mg/ml), calcium carbonate, calcium chloride and calcium gluconate Calcium carbonate is used for treatment of rickets, hypocalcemia and phosphate binders in chronic renal failure. Calcium chloride (10%) (Elemental calcium = 27.2mg/ml) is used in the treatment of hyperkalemia, calcium channel blocker toxicity, hypermagnesemia and hypocalcemic tetany. Calcium gluconate (10%) (Elemental calcium = 8.9mg/ml) is also used for the treatment of hypocalcemic tetany. Calcium EDTA is used in the treatment of lead toxicity. Calcium Lactate is one of the salts of calcium used as both nutritional supplements mainly in pregnant women.
Indication :
- Hypocalcemia
- Osteoporosis and osteomalacia
- Calcium carbonate is used for treating hyperphosphatemia in chronic renal failure
- Calcium carbonate is used as an antacid
- Calcium chloride is used to treat hyperkalemia
Contraindications :
Hypophosphatemia or Hyperphosphatemia.
Hypothyroidism.
Too much calcium in blood.
Dosing :
Hypocalcemia:
75-100 mg/kg/day PO of elemental calcium 4-12 hourly. Max: 1-2 gm/day.
Hypocalcemic tetany:
Calcium chloride (10%): 5-10 mg/kg/dose IV. Repeat 4-6 hourly if necessary.
Calcium gluconate (10%): 100-200 mg/kg IV over 5-10 mins. Repeat 4-6 hourly if necessary.
Calcium gluconate (10%): IV infusion: 200-800 mg/kg/day.
Hyperphosphatemia:
As a phosphate binder, calcium carbonate is given at 600-1800 mg of elemental calcium/meal along with meals.
Cardiac arrest:
Calcium gluconate (10%): 0.3 ml/kg as single IV bolus.
Adverse Effect :
Metastatic calcifications, nephrocalcinosis, extravasation of IV calcium chloride or gluconate can cause tissue necrosis, hypercalcemia, hypophosphatemia, dry mouth, constipation, belching, stomach pain, vomiting, abdominal distension, flatulence.
Interaction :
Ceftriaxone: Result in life-threatening damage to the lungs and kidneys.
Antibiotics: Decreases the absorption of antibiotics like quinolones.
Digoxin: Increases the effects of digoxin and lead to irregular heartbeats.
Diltiazem: Decreases the effectiveness of diltiazem.
Renal Dose :
Dose in Renal Impairment GFR (mL/min)
| 20-50 | Dose as in normal renal function. Titrate to response |
| 10-20 | Dose as in normal renal function. Titrate to response |
| <10 | Dose as in normal renal function. Titrate to response |
Dose in Patients undergoing Renal Replacement Therapies
| CAPD | Unknown dialysability. Dose as in normal renal function |
| HD | Unknown dialysability. Dose as in normal renal function |
| HDF/High flux | Unknown dialysability. Dose as in normal renal function |
| CAV/VVHD | Unknown dialysability. Dose as in normal renal function |
Hepatic Dose :
No dosage adjustments are recommended.