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9.5 Minerals

9.5.1 Calcium and magnesium

9.5.1.1 Calcium supplements

Sandocal 10000 effervescent tablets
'Calcichew', 'Calcichew Forte' tablets
Calcium chloride (10mmols/10ml)
Calcium gluconate injection (2.2mmols/10ml)

 

Notes:

1. Several bodies make recommendations for defined amounts of daily calcium for different physiological groups. Those of the National Osteoporosis Society (2001) are reproduced below with more detail available in the full document by clicking here.

COMA calcium recommendations

Age RNI*                   
0 - 12 months (breast fed only) 525 mg
1 - 3 years 350 mg
4 - 6 years 450 mg
7 - 10 years 550 mg
11 - 18 years boys / girls 1000 / 800 mg
19 + years 700 mg
Pregnant women 700 mg
Breastfeeding women 700 + 550 mg **

*RNI - Reference Nutrient Intake

**COMA notes that the additional increment may not be necessary with more recent

2. Calcium supplementation is no substitute for oestrogen in preventing perimenopausal bone loss. (See section 6.4 for suitable hormone replacement therapy).

 

9.5.1.2 Hypercalcemia and Hypercalciuria

Cinacalcet

This is included for initiation by renal specialists for treatment of refractory secondary hyperparathyroidism in patients with end-stage renal disease or maintenance dialysis therapy (as per NICE guidance, TA117). Also available for primary hyperparathyroidism (click here for shared care). Agreed criteria are:

1. The treatment of acute hypercalcaemia (calcium >3.0mmol/l) due to Primary Hyperparathyroidism, when parathyroidectomy is contraindicated or not clinically appropriate , and will avoid the need for further admission to hospital


2. The treatment of hypercalcaemia (Ca >3.0mm/l) in patients who are significantly symptomatic and awaiting surgery.

 

9.5.1.3 Magnesium 

Hypomagnesaemia
Co-magaldrox mixture (Maalox) – first-line (except for pts with short-bowel syndrome)
Magnesium aspartate (Magnaspartate) powder for oral solution – for pts with short-bowel syndrome
Magnesium sulphate injection

Note:

Link to UKMi document: “How is acute hypomanesaemia treated in adults”

 

9.5.2.1 Phosphorus supplements


Phosphate-Sandoz tablets effervescent
Potassium dihydrogen phosphate injection.
Sodium dihydrogen phosphate

Note:

Oral phosphate supplements may be required in addition to vitamin D in a small minority of patients with hypophosphataemic vitamin D-resistant rickets. Diarrhoea is a common side efecct and should prompt a reduction in dosage.

Link to “How is acute hypophosphataemia treated in adults” 

9.5.2.2 Phosphate-binding agents

All phosphate binding drugs are now GREEN after specialist initiation

Aluminium hydroxide mixture, capsules - 'Alu-Cap'
Calcium acetate tablets
Calcium carbonate + glycine - 'Titralac' tablets
Calcichew tablets
Lanthanum tablets (hospital prescribing only)
Sevelamer tablets, sachets

Phosphate binders for the long-term treatment of hyperphosphataemia in patients on dialysis, see link.

9.5.4 Zinc

Zinc sulphate MR spansules, effervescent tablets

Note:

The only definite indication for zinc supplementation is zinc deficiency. There is some evidence to suggest it may be useful in the prevention and treatment of pressure sores and treatment of burns.

For link to BNF section: 9.5 Minerals