Calcium supplement

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Calcium supplement
500 mg calcium supplements with vitamin D.jpg
500 milligram calcium supplements made from calcium carbonate
Clinical data
Trade names Alka-Mints, Calcet, Tums, others
AHFS/Drugs.com Monograph
License data
Routes of
administration 		By mouth, intravenous
ATC code
Identifiers
CAS Number
ChemSpider
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UNII

Calcium supplements are salts of calcium used in a number of conditions. [1] Supplementation is generally only required when there is not enough calcium in the diet. [2] [3] By mouth they are used to treat and prevent low blood calcium, osteoporosis, and rickets. [1] By injection into a vein they are used for low blood calcium that is resulting in muscle spasms and for high blood potassium or magnesium toxicity. [2] [4]

Contents

Common side effects include constipation and nausea. [1] When taken by mouth high blood calcium is uncommon. [1] Calcium supplements, unlike calcium from dietary sources, appear to increase the risk of kidney stones. [1] Adults generally require about a gram of calcium a day. [1] Calcium is particularly important for bones, muscles, and nerves. [1]

The medical use of calcium supplements began in the 19th century. [5] It is on the World Health Organization's List of Essential Medicines. [6] It is available as a generic medication. [3] In 2021, it was the 235th most commonly prescribed medication in the United States, with more than 1 million prescriptions. [7] [8] Versions are also sold together with vitamin D. [3] In 2020, the combination, calcium/vitamin D was the 215th most commonly prescribed medication in the United States, with more than 2 million prescriptions. [9] [10]

Health effects

Bone health

In healthy people, calcium supplementation is not necessary for maintaining bone mineral density, and carries risks that outweigh any benefits. [11] Calcium intake is not significantly associated with hip fracture risk in either men or women. [12] The US Preventive Service Task Force recommends against a daily supplement of calcium or vitamin D. [13] [14] Although a slight increase in bone mineral density occurred in healthy children from calcium supplementation, using additional dietary calcium is not justified, according to a 2006 review. [15]

Cardiovascular impact

There is good evidence that 1,000 mg to 1,500 mg of daily calcium supplementation can effect a modest reduction in blood pressure in adults who do not have a blood pressure condition, suggesting that achieving adequate calcium levels may have role in preventing high blood pressure. [16]

Cancer

The US National Cancer Institute does not recommend the use of calcium supplements for lowering the risk of cancer. [17] There is weak evidence calcium supplementation might have a preventative effect against developing colorectal adenomatous polyps, but the evidence is not sufficient to recommend such supplementation. [18]

Side effects

Excessive consumption of calcium carbonate antacids/dietary supplements (such as Tums) over a period of weeks or months can cause milk-alkali syndrome, with symptoms ranging from hypercalcemia to potentially fatal kidney failure. What constitutes "excessive" consumption is not well known and, it is presumed, varies a great deal from person to person. Persons consuming more than 10 grams/day of calcium carbonate (4 grams of elemental calcium) are at risk of developing milk-alkali syndrome, [19] but the condition has been reported in at least one person consuming only 2.5 grams/day of calcium carbonate (1 gram of elemental calcium), an amount usually considered moderate and safe. [20]

A 2023 systematic review found that calcium supplementation is not associated with myocardial infarction, stroke, heart failure admission, and cardiovascular/all-cause mortality. [21]

Calcium supplements may contribute to the development of kidney stones. [1]

Acute calcium poisoning is rare, and difficult to achieve without administering calcium intravenously. For example, the oral median lethal dose (LD50) for rats for calcium carbonate and calcium chloride are 6.45 [22] and 1.4 g/kg, [23] respectively.

Interactions

Calcium supplements by mouth diminish the absorption of thyroxine when taken within four to six hours of each other. [24] Thus, people taking both calcium and thyroxine run the risk of inadequate thyroid hormone replacement and thence hypothyroidism if they take them simultaneously or near-simultaneously, because significant amount of T4 is adsorbed to calcium carbonate depending on gastric pH levels, preventing absorption of T4 at the intestinal level. [25] [24]

Absorption

Calcium absorption in the gut is influenced by factors such as vitamin D levels, gut acidity, age, estrogen levels, and dietary fiber intake. It decreases with age, low vitamin D levels, hypochlorhydria, low estrogen levels, and a high-fiber diet. Calcium is absorbed both actively and passively in the small intestines, with low vitamin D levels impairing active absorption. Calcium absorption varies with serum 25-hydroxyvitamin D [25(OH)D] levels and is also influenced by dietary factors and genetics. Individuals vary in their ability to absorb calcium, with absorption inversely related to total dietary calcium intake, dietary fiber, alcohol intake, and physical activity, and positively associated with body mass index, dietary fat intake, and serum 1,25(OH2)D and parathyroid hormone levels. [26]

Excretion

Calcium is excreted from the human body primarily through urine and feces. Several factors can influence the rate of urinary calcium loss, including the intake of caffeine, protein, and sodium and low estrogen levels. Caffeine intake has been associated with bone loss, particularly in women aged 66-77 years. Women consuming more than 300 mg of caffeine per day usually experience greater bone loss in the spine than those consuming less than or equal to 300 mg per day. Genetic variants of the Vitamin D Receptor (VDR) also play a role. [26]

Types

The intravenous formulations of calcium include calcium chloride and calcium gluconate. [1] The forms that are taken by mouth include calcium acetate, calcium carbonate, calcium citrate, calcium gluconate, calcium lactate, and calcium phosphate. [1]


Vitamin D is added to some calcium supplements. Proper vitamin D status is important because vitamin D is converted to a hormone in the body, which then induces the synthesis of intestinal proteins responsible for calcium absorption. [49]

Labeling

For US dietary supplement and food labeling purposes, the amount in a serving is expressed in milligrams and as a percent of Daily Value (%DV). The labels indicate the weight of the elemental calcium in the supplement, not the total weight of the compound. For instance, in the case of calcium citrate, the label specifies the weight of the elemental calcium, not the entire calcium citrate compound. For calcium labeling purposes 100% of the Daily Value was 1000 mg, but in May 2016 it was revised to 1000–1300 mg. [50] A table of the pre-change adult Daily Values and references for the revision are provided at Reference Daily Intake. Food and supplement companies had until July 2018 to comply with the labeling change. [50]

Related Research Articles

<span class="mw-page-title-main">Calcium</span> Chemical element, symbol Ca and atomic number 20

Calcium is a chemical element; it has symbol Ca and atomic number 20. As an alkaline earth metal, calcium is a reactive metal that forms a dark oxide-nitride layer when exposed to air. Its physical and chemical properties are most similar to its heavier homologues strontium and barium. It is the fifth most abundant element in Earth's crust, and the third most abundant metal, after iron and aluminium. The most common calcium compound on Earth is calcium carbonate, found in limestone and the fossilised remnants of early sea life; gypsum, anhydrite, fluorite, and apatite are also sources of calcium. The name derives from Latin calx "lime", which was obtained from heating limestone.

<span class="mw-page-title-main">Riboflavin</span> Vitamin and supplement

Riboflavin, also known as vitamin B2, is a vitamin found in food and sold as a dietary supplement. It is essential to the formation of two major coenzymes, flavin mononucleotide and flavin adenine dinucleotide. These coenzymes are involved in energy metabolism, cellular respiration, and antibody production, as well as normal growth and development. The coenzymes are also required for the metabolism of niacin, vitamin B6, and folate. Riboflavin is prescribed to treat corneal thinning, and taken orally, may reduce the incidence of migraine headaches in adults.

<span class="mw-page-title-main">Thiamine</span> Chemical compound

Thiamine, also known as thiamin and vitamin B1, is a vitamin, an essential micronutrient for humans and animals. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosphorylated forms of thiamine are required for some metabolic reactions, including the breakdown of glucose and amino acids.

A nutrient is a substance used by an organism to survive, grow, and reproduce. The requirement for dietary nutrient intake applies to animals, plants, fungi, and protists. Nutrients can be incorporated into cells for metabolic purposes or excreted by cells to create non-cellular structures, such as hair, scales, feathers, or exoskeletons. Some nutrients can be metabolically converted to smaller molecules in the process of releasing energy, such as for carbohydrates, lipids, proteins, and fermentation products, leading to end-products of water and carbon dioxide. All organisms require water. Essential nutrients for animals are the energy sources, some of the amino acids that are combined to create proteins, a subset of fatty acids, vitamins and certain minerals. Plants require more diverse minerals absorbed through roots, plus carbon dioxide and oxygen absorbed through leaves. Fungi live on dead or living organic matter and meet nutrient needs from their host.

Fluoride is an inorganic, monatomic anion of fluorine, with the chemical formula F−
, whose salts are typically white or colorless. Fluoride salts typically have distinctive bitter tastes, and are odorless. Its salts and minerals are important chemical reagents and industrial chemicals, mainly used in the production of hydrogen fluoride for fluorocarbons. Fluoride is classified as a weak base since it only partially associates in solution, but concentrated fluoride is corrosive and can attack the skin.

<span class="mw-page-title-main">Mineral (nutrient)</span> Chemical element required as an essential nutrient by organisms to perform life functions

In the context of nutrition, a mineral is a chemical element. Some "minerals" are essential for life, most are not. Minerals are one of the four groups of essential nutrients, the others of which are vitamins, essential fatty acids, and essential amino acids. The five major minerals in the human body are calcium, phosphorus, potassium, sodium, and magnesium. The remaining elements are called "trace elements". The generally accepted trace elements are iron, chlorine, cobalt, copper, zinc, manganese, molybdenum, iodine, and selenium; there is some evidence that there may be more.

<span class="mw-page-title-main">Calcium in biology</span> Use of calcium by organisms

Calcium ions (Ca2+) contribute to the physiology and biochemistry of organisms' cells. They play an important role in signal transduction pathways, where they act as a second messenger, in neurotransmitter release from neurons, in contraction of all muscle cell types, and in fertilization. Many enzymes require calcium ions as a cofactor, including several of the coagulation factors. Extracellular calcium is also important for maintaining the potential difference across excitable cell membranes, as well as proper bone formation.

The Dietary Reference Intake (DRI) is a system of nutrition recommendations from the National Academy of Medicine (NAM) of the National Academies. It was introduced in 1997 in order to broaden the existing guidelines known as Recommended Dietary Allowances. The DRI values differ from those used in nutrition labeling on food and dietary supplement products in the U.S. and Canada, which uses Reference Daily Intakes (RDIs) and Daily Values (%DV) which were based on outdated RDAs from 1968 but were updated as of 2016.

<span class="mw-page-title-main">Calcium metabolism</span> Movement and regulation of calcium ions in and out of the body

Calcium metabolism is the movement and regulation of calcium ions (Ca2+) in (via the gut) and out (via the gut and kidneys) of the body, and between body compartments: the blood plasma, the extracellular and intracellular fluids, and bone. Bone acts as a calcium storage center for deposits and withdrawals as needed by the blood via continual bone remodeling.

<span class="mw-page-title-main">Calcium citrate</span> Chemical compound

Calcium citrate is the calcium salt of citric acid. It is commonly used as a food additive (E333), usually as a preservative, but sometimes for flavor. In this sense, it is similar to sodium citrate. Calcium citrate is also found in some dietary calcium supplements. Calcium makes up 24.1% of calcium citrate (anhydrous) and 21.1% of calcium citrate (tetrahydrate) by mass. The tetrahydrate occurs in nature as the mineral Earlandite.

ATC code A12Mineral supplements is a therapeutic subgroup of the Anatomical Therapeutic Chemical Classification System, a system of alphanumeric codes developed by the World Health Organization (WHO) for the classification of drugs and other medical products. Subgroup A12 is part of the anatomical group A Alimentary tract and metabolism.

<span class="mw-page-title-main">Vegetarian nutrition</span> Nutritional and human health aspects of vegetarian diets

Vegetarian nutrition is the set of health-related challenges and advantages of vegetarian diets.

<span class="mw-page-title-main">Calcium lactate</span> Chemical compound

Calcium lactate is a white crystalline salt with formula C
6H
10CaO
6, consisting of two lactate anions H
3C(CHOH)CO−
2 for each calcium cation Ca2+
. It forms several hydrates, the most common being the pentahydrate C
6H
10CaO
6·5H
2O.

<span class="mw-page-title-main">Tricalcium phosphate</span> Chemical compound

Tricalcium phosphate (sometimes abbreviated TCP), more commonly known as Calcium phosphate, is a calcium salt of phosphoric acid with the chemical formula Ca3(PO4)2. It is also known as tribasic calcium phosphate and bone phosphate of lime (BPL). It is a white solid of low solubility. Most commercial samples of "tricalcium phosphate" are in fact hydroxyapatite.

<span class="mw-page-title-main">Calcium gluconate</span> Chemical compound

Calcium gluconate is the calcium salt of gluconic acid and is used as a mineral supplement and medication. As a medication it is used by injection into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity. Supplementation is generally only required when there is not enough calcium in the diet. Supplementation may be done to treat or prevent osteoporosis or rickets. It can also be taken by mouth but is not recommended for injection into a muscle.

<span class="mw-page-title-main">Magnesium citrate</span> Chemical compound

Magnesium citrate is a magnesium preparation in salt form with citric acid in a 1:1 ratio. It contains 11.23% magnesium by weight.

Isostar is a sports drink sold in Europe. It is similar to Gatorade and Powerade in that it hydrates and provides energy through glucose. Isostar was first created in Switzerland in 1977.

<span class="mw-page-title-main">Vegan nutrition</span> Nutritional and human health aspects of vegan diets

Vegan nutrition refers to the nutritional and human health aspects of vegan diets. A well-planned vegan diet is suitable to meet all recommendations for nutrients in every stage of human life. Vegan diets tend to be higher in dietary fiber, magnesium, folic acid, vitamin C, vitamin E, and phytochemicals; and lower in calories, saturated fat, iron, cholesterol, long-chain omega-3 fatty acids, vitamin D, calcium, zinc, and vitamin B12.

Magnesium salts are available as a medication in a number of formulations. They are used to treat magnesium deficiency, low blood magnesium, eclampsia, and several other conditions. Magnesium is an essential nutrient.

References

  1. 1 2 3 4 5 6 7 8 9 10 "Calcium Salts". The American Society of Health-System Pharmacists. Archived from the original on 18 January 2017. Retrieved 8 January 2017.
  2. 1 2 World Health Organization (2009). Stuart MC, Kouimtzi M, Hill SR (eds.). WHO Model Formulary 2008. World Health Organization. p. 497. hdl: 10665/44053 . ISBN   978-92-4-154765-9.
  3. 1 2 3 British national formulary : BNF 69 (69 ed.). British Medical Association. 2015. pp. 694, 703. ISBN   978-0-85711-156-2.
  4. ↑ Hamilton R (2015). Tarascon Pocket Pharmacopoeia 2015 Deluxe Lab-Coat Edition. Jones & Bartlett Learning. pp. 215–216. ISBN   978-1-284-05756-0.
  5. ↑ Tegethoff FW (2012). Calcium Carbonate: From the Cretaceous Period into the 21st Century. Birkhäuser. p. 308. ISBN   978-3-0348-8245-3. Archived from the original on 16 January 2017.
  6. ↑ World Health Organization (2019). World Health Organization model list of essential medicines: 21st list 2019. Geneva: World Health Organization. hdl: 10665/325771 . WHO/MVP/EMP/IAU/2019.06. License: CC BY-NC-SA 3.0 IGO.
  7. ↑ "The Top 300 of 2021". ClinCalc. Archived from the original on 15 January 2024. Retrieved 14 January 2024.
  8. ↑ "Calcium - Drug Usage Statistics". ClinCalc. Archived from the original on 8 July 2020. Retrieved 14 January 2024.
  9. ↑ "The Top 300 of 2020". ClinCalc. Archived from the original on 23 June 2023. Retrieved 7 October 2022.{{cite web}}: CS1 maint: unfit URL (link)
  10. ↑ "Calcium; Vitamin D – Drug Usage Statistics". ClinCalc. Archived from the original on 5 June 2023. Retrieved 7 October 2022.
  11. ↑ Reid IR, Bristow SM, Bolland MJ (October 2015). "Calcium supplements: benefits and risks". Journal of Internal Medicine (Review). 278 (4): 354–368. doi: 10.1111/joim.12394 . PMID   26174589. S2CID   4679930.
  12. ↑ Bischoff-Ferrari HA, Dawson-Hughes B, Baron JA, Burckhardt P, Li R, Spiegelman D, et al. (December 2007). "Calcium intake and hip fracture risk in men and women: a meta-analysis of prospective cohort studies and randomized controlled trials". The American Journal of Clinical Nutrition. 86 (6): 1780–1790. doi: 10.1093/ajcn/86.5.1780 . PMID   18065599.
  13. ↑ Moyer VA (May 2013). "Vitamin D and calcium supplementation to prevent fractures in adults: U.S. Preventive Services Task Force recommendation statement". Annals of Internal Medicine. 158 (9): 691–696. doi:10.7326/0003-4819-158-9-201305070-00603. PMID   23440163. S2CID   23008867.
  14. ↑ "Recommendation: Vitamin D, Calcium, or Combined Supplementation for the Primary Prevention of Fractures in Community-Dwelling Adults: Preventive Medication". United States Preventive Services Taskforce. 17 April 2018. Archived from the original on 4 March 2024. Retrieved 4 March 2024.
  15. ↑ Winzenberg TM, Shaw K, Fryer J, Jones G (April 2006). "Calcium supplementation for improving bone mineral density in children". The Cochrane Database of Systematic Reviews. 2006 (2): CD005119. doi:10.1002/14651858.CD005119.pub2. PMC   8865374 . PMID   16625624.
  16. ↑ Cormick G, Ciapponi A, Cafferata ML, Cormick MS, Belizán JM (January 2022). "Calcium supplementation for prevention of primary hypertension". The Cochrane Database of Systematic Reviews (Systematic review). 1 (1): CD010037. doi:10.1002/14651858.CD010037.pub4. PMC   8748265 . PMID   35014026.
  17. ↑ "Calcium and Cancer Prevention: Strengths and Limits of the Evidence". National Cancer Institute. 4 May 2009. Archived from the original on 29 November 2014. Retrieved 2 November 2014.
  18. ↑ Weingarten MA, Zalmanovici A, Yaphe J (January 2008). "Dietary calcium supplementation for preventing colorectal cancer and adenomatous polyps". The Cochrane Database of Systematic Reviews (Review). 2008 (1): CD003548. doi:10.1002/14651858.CD003548.pub4. PMC   8719254 . PMID   18254022.
  19. ↑ Beall DP, Henslee HB, Webb HR, Scofield RH (May 2006). "Milk-alkali syndrome: a historical review and description of the modern version of the syndrome". The American Journal of the Medical Sciences. 331 (5): 233–242. doi:10.1097/00000441-200605000-00001. PMID   16702792. S2CID   45802184.
  20. ↑ Picolos MK, Orlander PR (2005). "Calcium carbonate toxicity: the updated milk-alkali syndrome; report of 3 cases and review of the literature". Endocrine Practice. 11 (4): 272–280. doi:10.4158/EP.11.4.272. PMID   16006300.
  21. ↑ Sim MG, Teo YN, Teo YH, Syn NL, Li TY, Yeo LL, et al. (September 2023). "Association Between Calcium Supplementation and the Risk of Cardiovascular Disease and Stroke: A Systematic Review and Meta-Analysis". Heart, Lung & Circulation. 32 (10): S1443–9506(23)04281–6. doi:10.1016/j.hlc.2023.07.008. PMID   37743221. S2CID   262224167.
  22. ↑ Lewis RJ (1996). Sax's Dangerous Properties of Industrial Materials (9th ed.). New York, NY: Van Nostrand Reinhold. p. 635. ISBN   978-0-471-37858-7.
  23. ↑ ITII. Toxic and Hazardous Industrial Chemicals Safety Manual. Tokyo, Japan: The International Technical Information Institute. 1988. p. 101.
  24. 1 2 Singh N, Singh PN, Hershman JM (June 2000). "Effect of calcium carbonate on the absorption of levothyroxine". JAMA. 283 (21): 2822–2825. doi:10.1001/jama.283.21.2822. PMID   10838651.
  25. ↑ Virili C, Antonelli A, Santaguida MG, Benvenga S, Centanni M (2019). "Gastrointestinal Malabsorption of Thyroxine". Endocrine Reviews. 40 (1): 118–136. doi:10.1210/er.2018-00168. hdl: 11568/936596 . PMID   30476027. Archived from the original on 23 February 2024. Retrieved 15 March 2024.
  26. 1 2 3 4 5 6 7 8 9 10 11 12 13 Straub DA (June 2007). "Calcium supplementation in clinical practice: a review of forms, doses, and indications". Nutr Clin Pract. 22 (3): 286–96. doi:10.1177/0115426507022003286. PMID   17507729.
  27. ↑ Weaver CM (2006). "29 Calcium". In Bowman BA, Russell RM (eds.). Present Knowledge in Nutrition. Vol. I (9th ed.). ILSI Press. p. 377. ISBN   978-1-57881-198-4.
  28. ↑ Shkembi B, Huppertz T (2021). "Calcium Absorption from Food Products: Food Matrix Effects". Nutrients. 14 (1): 180. doi: 10.3390/nu14010180 . PMC   8746734 . PMID   35011055.
  29. ↑ Hunt C, Nielsen F (2009). "Nutritional Aspects of Minerals in Bovine and Human Milks". Advanced Dairy Chemistry. pp. 391–456. doi:10.1007/978-0-387-84865-5_10. ISBN   978-0-387-84864-8.
  30. ↑ https://www.journalofdairyscience.org/article/S0022-0302%2887%2980305-3/pdf
  31. ↑ "Office of Dietary Supplements - Calcium".
  32. 1 2 Fritz K, Taylor K, Parmar M (2024). Calcium Carbonate. PMID   32965974.
  33. ↑ Remington J (2005). Remington: The Science and Practice of Pharmacy. Lippincott Williams & Wilkins. p. 1338. ISBN   978-0-7817-4673-1.
  34. ↑ Zhao Y, Martin BR, Weaver CM (October 2005). "Calcium bioavailability of calcium carbonate fortified soymilk is equivalent to cow's milk in young women" (PDF). The Journal of Nutrition. 135 (10): 2379–2382. doi: 10.1093/jn/135.10.2379 . PMID   16177199. Archived (PDF) from the original on 18 September 2017.
  35. ↑ Martini L, Wood RJ (December 2002). "Relative bioavailability of calcium-rich dietary sources in the elderly". The American Journal of Clinical Nutrition. 76 (6): 1345–1350. doi: 10.1093/ajcn/76.6.1345 . PMID   12450902.
  36. ↑ "Office of Dietary Supplements - Calcium". Archived from the original on 17 March 2018. Retrieved 15 March 2024.
  37. ↑ White CM (March 2022). "Lead in Mineral or Multivitamin-Multimineral Products". Ann Pharmacother. 56 (3): 339–345. doi:10.1177/10600280211023328. PMID   34096339.
  38. 1 2 Castelo-Branco C, Ciria-Recasens M, Cancelo-Hidalgo MJ, Palacios S, Haya-Palazuelos J, Carbonell-Abelló J, et al. (2009). "Efficacy of ossein-hydroxyapatite complex compared with calcium carbonate to prevent bone loss: a meta-analysis". Menopause. 16 (5): 984–91. doi:10.1097/gme.0b013e3181a1824e. PMID   19407667.
  39. ↑ Maton PN, Burton ME (1999). "Antacids Revisited" . Drugs. 57 (6): 855–870. doi:10.2165/00003495-199957060-00003. PMID   10400401. Archived from the original on 20 April 2023. Retrieved 15 March 2024.
  40. ↑ Garg V, Narang P, Taneja R (2022). "Antacids revisited: Review on contemporary facts and relevance for self-management". Journal of International Medical Research. 50 (3). doi:10.1177/03000605221086457. PMC   8966100 . PMID   35343261.
  41. 1 2 3 Straub DA (June 2007). "Calcium supplementation in clinical practice: a review of forms, doses, and indications". Nutrition in Clinical Practice. 22 (3): 286–296. doi:10.1177/0115426507022003286. PMID   17507729.
  42. ↑ Martin BR, Weaver CM, Heaney RP, Packard PT, Smith DL (June 2002). "Calcium absorption from three salts and CaSO(4)-fortified bread in premenopausal women". Journal of Agricultural and Food Chemistry. 50 (13): 3874–3876. doi:10.1021/jf020065g. PMID   12059174.
  43. 1 2 Bendich A (January 2001). "Calcium supplementation and iron status of females". Nutrition. 17 (1): 46–51. doi:10.1016/s0899-9007(00)00482-2. PMID   11165888.
  44. ↑ "Calcium Chloride: Indications, Side Effects, Warnings". Archived from the original on 17 February 2023. Retrieved 15 March 2024.
  45. ↑ https://www.industrialchemicals.gov.au/sites/default/files/Calcium%20chloride%20%28CaCl2%29_Human%20health%20tier%20II%20assessment.pdf
  46. ↑ Remes-Troche JM (2013). "A 'black stomach' due to ingestion of anhydrous calcium chloride". BMJ Case Reports. 2013: bcr2012007716. doi:10.1136/bcr-2012-007716. PMC   3604345 . PMID   23283618.
  47. ↑ Hagiwara Y, Seki K, Takahashi Y (2020). "Oral chemical burn due to accidental ingestion of calcium oxide food desiccant in a patient with dementia". Journal of International Medical Research. 48 (4). doi:10.1177/0300060520920065. PMC   7223204 . PMID   32338100.
  48. ↑ Nakagawa Y, Maeda A, Takahashi T, Kaneoka Y (2020). "Gastric Necrosis because of Ingestion of Calcium Chloride". ACG Case Reports Journal. 7 (8): e00446. doi:10.14309/crj.0000000000000446. PMC   7447462 . PMID   32903978.
  49. ↑ Combs G (2008). The Vitamins. Academic Press. p.  161. ISBN   978-0-12-183490-6.
  50. 1 2 "Regulations.gov". www.regulations.gov. Archived from the original on 5 December 2022. Retrieved 18 January 2023.
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