calcium citrate

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calcium

 (Ca) [kal´se-um]
a chemical element, atomic number 20, atomic weight 40.08. (See Appendix 6.) Calcium is the most abundant mineral in the body. In combination with phosphorus it forms calcium phosphate, the dense, hard material of the bones and teeth. It is an important cation in intracellular and extracellular fluid and is essential to the normal clotting of blood, the maintenance of a normal heartbeat, and the initiation of neuromuscular and metabolic activities.

Within the body fluids calcium exists in three forms. Protein-bound calcium accounts for about 47 per cent of the calcium in plasma; most of it in this form is bound to albumin. Another 47 per cent of plasma calcium is ionized. About 6 per cent is complexed with phosphate, citrate, and other anions.

Ionized calcium is physiologically active. One of its most important physiological functions is control of the permeability of cell membranes. Parathyroid hormone, which causes transfer of exchangeable calcium from bone into the blood stream, maintains calcium homeostasis by preventing either calcium deficit or excess.

Hypercalcemia: This is when the level of serum calcium rises above normal; neuromuscular activity begins to diminish. Symptoms include lethargy, muscle weakness (which, as the level of calcium increases, can progress to depressed reflexes and hypotonic muscles), constipation, mental confusion, and coma. The heartbeat also slows, which potentiates the effects of digitalis.

Hypocalcemia: This is a serum level of calcium that is below normal; it is manifested by increased neuromuscular irritability. When there is a deficit of ionized calcium, the nerve cells become more permeable, allowing leakage of sodium and potassium from the cells. This produces excitation of the nerve fibers and triggers uncontrollable activity of the skeletal muscles. Hence, as the calcium level continues to drop, the patient begins to experience muscle twitching and cramping, grimacing, and carpopedal spasm, which can quickly progress to tetany, laryngospasm, convulsions, cardiac arrhythmias, and eventually to respiratory and cardiac arrest. Relatively early signs of hypocalcemia are a positive trousseau's sign and a positive chvostek's sign.

Dietary sources of calcium include dairy products (such as milk and cheese), soybeans, fortified orange juice, dark green leafy vegetables (such as mustard greens and broccoli), sardines, clams, and oysters. The recommended dietary allowance of calcium for children aged 4 to 8 is 800 mg, and that for women aged 50 to 70 is 1200 mg. (See tables in the Appendices for recommended dietary allowances across the life span.) It is difficult to meet these requirements without including milk or milk products in the daily diet. The most familiar calcium deficiency disease is rickets, in which the bones and teeth soften. However, it is believed that a large number of people suffer from subclinical calcium deficiency because of poor eating habits. Since calcium is essential to the formation and maintenance of strong bones, an adequate intake is important in the prevention of osteoporosis.
calcium acetate the calcium salt of acetic acid; administered orally as a source of calcium and as a phosphate binder, such as in patients with end-stage renal disease. Also used as a pharmaceutical buffering agent.
calcium carbonate an insoluble salt occurring naturally in bone, shells, and chalk; used as an antacid, calcium supplement, and phosphate binder, and for treatment of osteoporosis.
calcium channel blocker (calcium channel blocking agent) a drug such as nifedipine, diltiazem, or verapamil that selectively blocks the influx of calcium ions through a calcium channel of cardiac muscle and smooth muscle cells; used in the treatment of Prinzmetal's angina, chronic stable angina, and cardiac arrhythmias. Calcium channel blocking agents act to control arrhythmias by slowing the rate of sinoatrial node discharge and the conduction velocity through the atrioventricular node. They act in vasospastic angina to relax and prevent coronary artery spasm. The mechanism of action in classical angina is a lowering of myocardial oxygen utilization by dilating peripheral arteries and thereby reducing total peripheral resistance and the work of the heart.
 Physiologic activity of calcium channel blockers. (Data from Hardman J. and Limbird L., editors: Goodman and Gilman's The Pharmacologic Basis of Therapeutics, 9th ed., New York, McGraw-Hill, 1996; and the National Institutes of Health: The Sixth Report of the Joint National Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure, NIH Pub. No. 98-4080, Washington, DC, GPO, 1998.) From Edmunds and Mayhew, 2000.
calcium chloride a salt used in solution to restore electrolyte balance, treat hypocalcemia, and act as a treatment adjunct in cardiac arrest and in magnesium poisoning.
calcium citrate a salt used as a calcium replenisher; also used in the treatment of hyperphosphatemia in renal osteodystrophy.
calcium glubionate a calcium replenisher, used as a nutritional supplement and for the treatment of hypocalcemia; administered orally.
calcium gluceptate a calcium salt administered intramuscularly or intravenously in the prevention and treatment of hypocalcemia and as an electrolyte replenisher.
calcium gluconate a calcium salt administered intravenously or orally in the treatment and prevention of hypercalcemia and as a nutritional supplement. It is also administered by injection as a treatment adjunct in cardiac arrest and in the treatment of hyperkalemia.
calcium hydroxide an astringent compound used topically in solution or lotions.
calcium lactate a calcium replenisher, administered orally in the treatment and prevention of hypocalcemia and as a nutritional supplement.
calcium oxalate a salt of oxalic acid, which in excess in the urine may lead to formation of oxalate urinary calculi.
calcium oxide lime (def. 1).
calcium pantothenate a calcium salt of the dextrorotatory isomer of the B vitamin pantothenic acid; used as a nutritional supplement. It is also available as racemic calcium pantothenate, which is a mixture of the dextrorotatory and levorotatory isomeric forms.
calcium phosphate a salt containing calcium and the phosphate radical; dibasic and tribasic calcium phosphate are used as sources of calcium.
calcium polycarbophil a hydrophilic agent used as a bulk laxative.
calcium propionate a salt used as an antifungal preservative in foods and as a topical antifungal agent.
calcium pyrophosphate the pyrophosphate salt of calcium, used as a polishing agent in dentifrices. Crystals of the dihydrate form occur in the joints in calcium pyrophosphate deposition disease.
calcium pyrophosphate deposition disease an acute or chronic inflammatory arthropathy caused by deposition of crystals of calcium pyrophosphate dihydrate in the joints and synovial fluid and chondrocalcinosis. Clinically, it may resemble numerous other connective tissue diseases such as arthritis and gout, or it may be asymptomatic. Acute attacks are sometimes called pseudogout.
calcium sulfate a compound of calcium and sulfate, occurring as gypsum or as plaster of paris.

calcium citrate

(kal-see-um si-trate) ,

Cal-Citrate 250

(trade name),

Citrical

(trade name),

Citrical Liquitab

(trade name)

Classification

Therapeutic: mineral electrolyte replacements supplements
Pregnancy Category: C

Indications

Treatment and prevention of hypocalcemia.Adjunct in the prevention of postmenopausal osteoporosis.

Action

Essential for nervous, muscular, and skeletal systems.
Maintain cell membrane and capillary permeability.
Act as an activator in the transmission of nerve impulses and contraction of cardiac, skeletal, and smooth muscle.
Essential for bone formation and blood coagulation.
Treatment of hyperphosphatemia in end-stage renal disease.

Therapeutic effects

Replacement of calcium in deficiency states. Control of hyperphosphatemia in end-stage renal disease without promoting aluminum absorption.

Pharmacokinetics

Absorption: Absorption from the GI tract requires vitamin D.
Distribution: Readily enters extracellular fluid. Crosses the placenta and enters breast milk.
Metabolism and Excretion: Excreted mostly in the feces; 20% eliminated by the kidneys.
Half-life: Unknown.

Time/action profile (effects on serum calcium)

ROUTEONSETPEAKDURATION
POunknownunknownunknown
IVimmediateimmediate0.5–2 hr

Contraindications/Precautions

Contraindicated in: Hypercalcemia; Renal calculi; Ventricular fibrillation.
Use Cautiously in: Patients receiving digitalis glycosides; Severe respiratory insufficiency; Renal disease; Cardiac disease.

Adverse Reactions/Side Effects

Central nervous system

  • headche
  • tingling

Cardiovascular

  • arrhythmias (most frequent)
  • bradycardia

Gastrointestinal

  • constipation (most frequent)
  • nausea
  • vomiting

Genitourinary

  • calculi
  • hypercalciuria

Interactions

Drug-Drug interaction

Hypercalcemia increases the risk of digoxin toxicity.Chronic use with antacids in renal insufficiency may lead to milk-alkali syndrome.Ingestion by mouth decreases the absorption of orally administered tetracyclines, fluoroquinolones, phenytoin, and iron salts.Excessive amounts may decrease the effects of calcium channel blockers.Decreases absorption of etidronate and risedronate (do not take within 2 hr of calcium supplements).May decrease the effectiveness of atenolol.Concurrent use with diuretics (thiazide) may result in hypercalcemia.May decrease the ability of sodium polystyrene sulfonate to decrease serum potassium.Cereals, spinach, or rhubarb may decrease the absorption of calcium supplements.Calcium acetate should not be given concurrently with other calcium supplements.

Route/Dosage

1 gram of calcium citrate contains 211 mg elemental calcium (10.6 mEq calcium). Doses are expressed in terms of elemental calcium.
Oral (Adults) Prevention of hypocalcemia, treatment of depletion, osteoporosis—1–2 g/day in 3–4 divided doses.
Oral (Children) Supplementation—45–65 mg/kg/day in 4 divided doses.
Oral (Infants) Neonatal hypocalcemia—50–150 mg/kg in 4–6 divided doses (not to exceed 1 g/day).

Availability

Tablets: 250 mgOTC (53 mg elemental calcium), 950 mgOTC (200 mg elemental calcium)
Granules: 760 mg/teaspoonful (equivalent to 161 mg elemental calcium per teaspoonful)

Nursing implications

Nursing assessment

  • Calcium Supplement/Replacement: Observe patient closely for symptoms of hypocalcemia (paresthesia, muscle twitching, laryngospasm, colic, cardiac arrhythmias, Chvostek’s or Trousseau’s sign). Notify physician or other health care professional if these occur. Protect symptomatic patients by elevating and padding siderails and keeping bed in low position.
    • Monitor patient on digitalis glycosides for signs of toxicity.
  • Lab Test Considerations: Monitor serum calcium or ionized calcium, chloride, sodium, potassium, magnesium, albumin, and parathyroid hormone (PTH) concentrations before and periodically during therapy for treatment of hypocalcemia.
    • May cause decreased serum phosphate concentrations with excessive and prolonged use. When used to treat hyperphosphatemia in renal failure patients, monitor phosphate levels.
  • Assess patient for nausea, vomiting, anorexia, thirst, severe constipation, paralytic ileus, and bradycardia. Contact physician or other health care professional immediately if these signs of hypercalcemia occur.

Potential Nursing Diagnoses

Imbalanced nutrition: less than body requirements (Indications)
Risk for injury, related to osteoporosis or electrolyte imbalance (Indications)

Implementation

  • Oral: Administer with plenty of fluids with or following meals.

Patient/Family Teaching

    • Do not administer concurrently with foods containing large amounts of oxalic acid (spinach, rhubarb), phytic acid (brans, cereals), or phosphorus (milk or dairy products). Administration with milk products may lead to milk-alkali syndrome (nausea, vomiting, confusion, headache). Do not take within 1–2 hr of other medications if possible.
    • Instruct patients on a regular schedule to take missed doses as soon as possible, then go back to regular schedule.
    • Advise patient to avoid excessive use of tobacco or beverages containing alcohol or caffeine.
  • Calcium Supplement: Encourage patients to maintain a diet adequate in vitamin D (see ).
  • Osteoporosis: Advise patients that exercise has been found to arrest and reverse bone loss. Patient should discuss any exercise limitations with health care professional before beginning program.

Evaluation/Desired Outcomes

  • Increase in serum calcium levels.
  • Decrease in the signs and symptoms of hypocalcemia.

calcium citrate

a salt used as a calcium replenisher and in the treatment of hyperphosphatemia in renal osteodystrophy.
References in periodicals archive ?
The following products are included in the report: Bayer Citracal Slow Release 1200, The Vitamin Shoppe Calm Zone Magnesium, Caltrate 600+D Plus Minerals, Cardiovascular Research Ltd.
Mission's expertise in solid dose tablet manufacturing has earned it international manufacturing agreements, including manufacturing Citracal for Bayer Consumer Care and its affiliate companies.
The program, which enlists model and author Dayle Haddon, is designed to encourage women to focus on inner strength as the foundation of beauty--and consider adding Citracal, Bayer's calcium supplement, to their daily "age-defying health and beauty routine to support bone health.
There is a difference between calcium supplements," claims the Citracal Web site.
Mission Pharmacal, San Antonio, TX, has introduced Citracal Prenatal 90 + DHA, which the company says improves the nutritional health of women and their children prior to conception, throughout pregnancy, and in the postnatal period.
So you can guess the price of a Presto Salad Shooter or a bottle of Citracal, and, within a hundred dollars or so, the price of a sleep set and a car.
All participants in both study groups received a daily supplement of calcium carbonate (630 mg) and vitamin D3 (200 N = 5 [micro]g; Citracal + D; Mission Pharmacal).
The commercial availability of Citracal has provided the public with a superior calcium supplement with higher bioavailability.
i] Today, Bayer HealthCare, the makers of calcium supplement brand Citracal, is partnering with beauty icon and author, Dayle Haddon and Susan Randall, Senior Director of Science and Education for the National Osteoporosis Foundation (NOF) to announce the launch of Beauty is Bone Deep, a national campaign that encourages women to focus on inner strength (physical and emotional) as the foundation of beauty and consider adding Citracal to their daily age-defying health and beauty routine to support bone health[sup.
She also suggested selecting chewable or soluble calcium products, such as Citracal liquitabs, rather than large pills or tablets.
A transcortical iliac crest bone biopsy was obtained from each patient after obtaining informed consent and before beginning calcium citrate therapy (400 mg of calcium twice daily as Citracal [R], Mission Pharmacal).