Infants with cholestasis who have documented deficiencies require 25-100 mg/kg/day up to 800-1000 mg Calcium (dosage varies and needs to adjust based on serum levels)-remember to correct serum calcium for low albumin level [(4.0-albumin) x 0.8 + serum Calcium = corrected Calcium level]. Adequate vitamin D is also required (25-OH Vitamin D3): 3-10 x DRI/age.
Wieman RA, Balistreri WF. Nutrition Support in Children with Liver disease, In: Baker SS, Baker RD, Davis AM, eds. Pediatric Nutrition Support. Sudbury, MA: Jones and Bartlett Publishers; 459-475.
Taylor RM, Dhawan A. Assessing Nutritional Status in Children with Chronic Liver Disease. J GastrenHepatol. 2005;20:1817-1824.
Supplementation of calcium and vitamin D is an important issue in liver cirrhosis, particularly in primary biliary cirrhosis (prevalence of osteoporosis of 12 to 52%) and in other long-term cholestatic syndromes. The use of bisphosphonate must also be considered when bone disease is already installed.
Ref.
Metabolic bone disease in primary biliary cirrhosis - UpToDate in
http://www.uptodate.com/contents/metabolic-bone-disease-in-primary-biliary-cirrhosis?source=machineLearning&search=CIRRHOSIS+AND+CALCIUM&selectedTitle=10~150§ionRank=2&anchor=H15421748#H15421748
http://www.ncbi.nlm.nih.gov/pubmed/?term=22483016
As evidenced by other collegues, Calcium supplementation is important in presence of cholestasis and therefore not in all cases of cirrhosis. However, in presence of cirrhosis not associated to cholestasis, comorbidities should be considered. Finally, it should be considered that cirrhosis can determine low albumine levels, and consequently, false low calcium levels.
Cirrhosis it self does not requiere calcium,but can be added calcium when osteopenia or osteoporosis established .It is notworthy to say that osteoporosis is frequently viwed in cirrhotic patients, especially in women, irrespective of etiology of cirrhosis , and is more severe in advance liver disease. Do not requiered supplementation just because of low levels of calcium (false low due to levels of albumin)
Many essential concepts have already been reported. I should like, to emphasize the possibility of calcium depletion and consequent need of supplementation in cirrrhotic patients with ascites who assume diuretics for a long period.
Cirrhosis is itself a state of malnutrition. Studies have shown decreased bone mineral density. Hence calcium and Vitamin D supplementation is needed.
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