Dear Mohammad

 Albumin is a negative acute phase protein and patients with low albumins have low ionized calciums as measured by most conventional analyzers. The evidence is summarised in the Discussion of my paper with Paul Masters in Clin Chem 1993: 39; 1082-5.

I don't know why your ICU patients have a lot of low adjusted calciums. The few published papers from ICUs comparing adjusted calcium with ionized calcium in acutely ill patients complain of the opposite: adjusted calciums are usually normal while ionized calciums are low (because albumin falls rapidly in acute illness)!

With best wishes

Brian Payne

On 22/11/2012 12:29, Mohammad Al-Jubouri wrote:
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Dear All,
 
We only measure total calcium reported as adjusted calcium on ICU patients and a significant number have low results. An ICU calcium replacement protocol is instigated, however the calcium result remains low. Now ICU wants ionised calcium added to their blood gas machine for monitoring calcium status of their patients.
 
Any words of wisdom on the clinical usefulness of inoised calcium in this setting is welcome.
 
Many thanks
 
Mohammad
 
Dr. M A Al-Jubouri, MB ChB, MSc, FRCP Edin, FRCPath
Consultant Chemical Pathologist
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