Mineral Supplementation Guidelines

Introduction to Mineral Supplements

Calcium carbonate, the most common form of calcium supplement, requires gastric acid for optimal absorption and should be taken with meals, as recommended by the American College of Physicians and the American Gastroenterological Association 1, 1

Calcium-containing phosphate binders should be taken with meals to obtain maximal phosphorus-binding efficacy and minimal intestinal absorption of free calcium, according to the National Kidney Foundation 2
Phosphate supplements should not be given with calcium-rich foods, as this reduces absorption, according to the American College of Nephrology 3

Patients with certain conditions, such as achlorhydria or those taking acid-reducing medications, may benefit from calcium citrate instead of tricalcium phosphate, as it doesn't require gastric acid for absorption 1
For patients with chronic kidney disease, phosphate supplementation should be used with caution, monitoring PTH levels closely and reducing or discontinuing phosphate if PTH rises significantly, as recommended by the American Journal of Kidney Diseases and Nature Reviews Nephrology 4, 3

Oral phosphate supplementation is usually sufficient for patients with normal kidney function, with a dosage of 750-1600 mg/day of elemental phosphorus, divided into 2-3 doses daily to improve absorption and tolerance 4
Intravenous phosphate replacement is reserved for severe, symptomatic cases, with an initial dose based on body weight and administration rate until serum level reaches a target value, as recommended by Nature Reviews Nephrology 4, 3
Potential complications of phosphate supplementation include hyperphosphatemia, hypocalcemia, nephrocalcinosis, hyperkalemia, and diarrhea, and monitoring for these complications is crucial, according to Nature Reviews Nephrology and the American College of Nephrology 4, 3

Serum phosphate, calcium, potassium, and renal function should be monitored during IV administration, and serum phosphate, calcium, and PTH should be checked regularly, as recommended by Nature Reviews Nephrology 4, 3
Determining the underlying cause of hypophosphatemia is crucial for effective management, and normalization of serum phosphate levels is not a goal of conventional therapy for chronic hypophosphatemic disorders, according to the American Journal of Hematology and Nature Reviews Nephrology 3, 5
Mild hypophosphatemia generally does not require immediate treatment unless symptomatic, and management should focus on identifying and addressing the underlying cause while monitoring for progression to more severe deficiency, as recommended by the American College of Nephrology 3

Ferric carboxymaltose-induced hypophosphatemia should be managed by cessation of FCM and consideration of alternative iron formulations in high-risk patients, according to the American Journal of Hematology 5
X-linked hypophosphatemia may be treated with burosumab in children and lower doses of active vitamin D and oral phosphate in adults, as recommended by the American College of Nephrology 3
Secondary hyperparathyroidism management involves increasing active vitamin D dose and/or decreasing phosphate supplements if PTH levels are elevated, according to the American College of Nephrology 3
Excessive phosphate supplementation should be avoided to prevent hyperphosphatemia, secondary hyperparathyroidism, hypocalcemia, and nephrocalcinosis, as warned by the American College of Nephrology and the Praxis Medical Insights 3, 6