Parenteral Calcium Needs in Crohn's Disease

Calcium plays a vital role in maintaining bone strength and bone density. Any disease that affects the immune system, such as Crohn’s disease, can result in poor absorption of important minerals like calcium. When the digestive tract is inflamed, as is the case when your immune system is trying to fight off invading microorganisms, vitamins and minerals cannot be properly absorbed and put to use in the body.

Crohn's Disease

• Crohn’s disease affects the digestive tract, and is sometimes referred to as inflammatory bowel disease. People with Crohn’s have an inflammation of the small intestine, which is the main site of digestion. In the small intestine, digestive juices from the liver and the pancreas mix with food to break it down into small molecules. The nutrients can then be absorbed through the surface of the small intestine, and transported to the rest of the body via the bloodstream. When the small intestine is inflamed, those nutrients will not be absorbed or will not be absorbed fully, which can result in deficiencies or malnourishment.

Calcium Deficiency Risk

• The degree of impairment and inflammation to the small intestine affects how vitamins and minerals are absorbed. The location of the disease also plays a role, as different nutrients are absorbed in different sections of the intestine. Calcium is a common deficiency in Crohn’s patients because of multiple factors. Symptoms of lactose intolerance are often similar to those of Crohn’s disease, so many people avoid any dairy products. For people who do consume dairy, it may not be absorbed properly because of disease. Medications that are commonly used to treat Crohn’s, such as prednisone or other steroids, also affect bone health by slowing the formation of new bone and speeding up the breakdown of old bone.

Parenteral Nutrition

• Typically used as a last resort for severe malnourishment, parenteral nutrition might be considered to correct deficiencies. Parenteral nutrition (PN), or nutrition given intravenously, is delivered through a catheter in a large blood vessel. PN is not routinely used for patients with a functioning GI tract, as it can cause more complications by preventing the stomach from working normally and failing to preserve its structure. However, for patients needing bowel rest so that the area can heal, PN may be the only way to meet their nutritional needs. For Crohn’s patients, this might be the case in extreme scenarios.

Parenteral Calcium

• When giving PN, the formula must be adjusted to meet the needs of the individual patients. Several factors, such as age, weight and degree of deficiency, affect the amount of calories, protein, vitamins and minerals in the formula. According to the Merck manual, the basic adult requirement for PN calcium is 15 milliequivalents (mEq). Calcium supplements are usually measured in milligrams when taken by mouth, 15 mEq is equal to about 300 mg. When taken PN, the calcium is directly absorbed so less is needed. The PN calcium requirement is also the recommended amount for hypocalcemia (low calcium). Special efforts should be taken to make sure there are no harmful interactions between nutrients that could affect their potency. For example, a magnesium deficit could result in sodium, potassium and calcium negative balances.

Crohn's Disease Management

• There is no specific diet or eating plan to help people with Crohn’s, so all recommendations must be individualized. The disease changes over time, and periods of increased inflammation might require more restrictions. Basic recommendations for the diet are to avoid foods that cause digestive problems, such as gas, bloating, cramps and diarrhea. People with Crohn’s should be sure to drink enough fluids to avoid dehydration. Anti-inflammatory drugs, such as corticosteroids, are often the first step in treatment, along with immune system suppressors, such as Remicade. Antibiotics and anti-diarrheals might also be used. Common vitamin and mineral supplements include calcium and vitamin D, vitamin B-12, iron, potassium and magnesium.