Calcium Supplements & Deficiencies

• Calcium supplements are prescribed for hypocalcemia and individuals at risk of calcium deficiency, including adolescents, pregnant or breastfeeding women, postmenopausal women, and those with lactose intolerance or at risk of osteoporosis.
• Calcium carbonate is a key component in antacids used for gastric hyperacidity.
• Calcium supplements fall under the classification of Mineral and Electrolyte Supplements

Prototype Medications

• Calcium citrate is mainly used for calcium replacement as a dietary supplement.
• Calcium carbonate is primarily used as an antacid but can also be used as a calcium supplement.
• Vitamin D enhances calcium absorption from the intestine and is often used with calcium supplements.

Expected Action

• Calcium supplements provide a non-dietary calcium source and can neutralize gastric acid.

Adverse Reactions

• Long-term use of calcium supplements or antacids, especially with vitamin D, can lead to hypercalcemia.
• Symptoms of hypercalcemia include nausea, vomiting, constipation, increased urine output (polyuria), and depression.
• Hypercalcemia can also lead to renal calculi (kidney stones) and hypercalciuria.

Interventions

• Monitor serum calcium levels in clients taking calcium supplements or antacids.
• Watch for manifestations of decreased gastric and intestinal motility (nausea, vomiting, constipation).
• Monitor urine output, flank pain, and blood in the urine.

Administration

• Calcium supplements can be administered orally or intravenously.
• Give calcium supplements 1 hour before or 1 to 2 hours after glucocorticoids, thyroid supplements, and tetracycline/quinolone antibiotics.
• Administer calcium-based antacids 1 hour after meals with a full glass of water, and again at bedtime.

Client Instructions

• Report symptoms of hypercalcemia to the provider, including nausea, vomiting, increased urine output, and depression.
• Prevent constipation by eating a high-fiber diet, increasing water consumption, and using laxatives if needed; fiber supplements or stool softeners may also be helpful.
• Report flank pain or blood in the urine due to the increased risk of kidney stones.
• Take calcium supplements 1 hour before or 1 to 2 hours after glucocorticoids, thyroid supplements, and tetracycline/quinolone antibiotics.
• Take calcium-based antacids 1 hour after meals and at bedtime, chew the tablet before swallowing, and drink a glass of water afterward.
• Do not take more than 600 mg of calcium at one time to ensure proper absorption.
• Read product labels for bioavailability information; calcium citrate and chewable forms have higher bioavailability.
• Consume the daily recommended amount of elemental calcium based on age and childbearing status.

Contraindications and Precautions

• Calcium supplements are contraindicated in clients with hypercalcemia or low phosphate levels.
• Use with caution in clients with a history of kidney stones or cardiac dysrhythmias.
• Administer cautiously to clients with slow gastric motility.

Interactions

• Excessive calcium supplements can increase the risk of digoxin toxicity.
• Glucocorticoids decrease calcium absorption.
• Calcium supplements can decrease the absorption of thyroid hormones, tetracycline, and quinolone antibiotics.
• Thiazide diuretics may increase the risk of hypercalcemia due to decreased calcium excretion.
• Foods like cereals, rhubarb, and spinach can decrease calcium absorption if consumed close to supplement intake.

Medication Questions

• Raloxifene and Alendronate are effective in both disease prevention and treatment of osteoporosis.
• Nausea is an indication of hypercalcemia.

Matching

• Raloxifene mimics the effects of estrogen on the bones.
• Alendronate reduces the number of osteoclasts.
• Calcitonin salmon raises calcium levels.
• Thiazide diuretics increase the excretion of calcium.