This case depicts an elevated total calcium with apparently normal ionized
calcium. First, is the total calcium level expected to be elevated due
to a high albumin concentration ? (unlikely). Secondly, the ionized
calcium level in an acutely ill patient should be interpretted with the pH
of the sample. ((For example, an ionized calcium level of 1.15 mmol/L can
be obtained in serum which has a high total calcium and is alkalotic )).
The third facor I would consider is: How was the ionized calcium specimen
collected (any anticoagulant ? any delay in analyses?).
That would be my trouble-shooting approach. regards, Andrew
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Andrew Lyon, Clinical Biochemist email: [log in to unmask]
Saskatoon, SASK, CANADA. homepage: http://duke.usask.ca/~lyona
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