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A corrected calcium level based on the albumin level is: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 * (4.0 - serum albumin [g/dL]). [20] Since calcium is also bound to small anions, it may be more useful to correct total calcium for both albumin and the anion gap. [21] [22]
A number of hormones (e.g. thyroxine, cortisol, testosterone), drugs, and other molecules are bound to albumin in the bloodstream and must be released from albumin before becoming biologically active. For example, calcium binds to albumin; in hypoalbuminemia, there is an increased amount of free ionized calcium, its biologically active form.
The amount of biologically active calcium varies with the level of serum albumin, a protein to which calcium is bound, and therefore levels of ionized calcium are better measures than a total calcium; however, one can correct a total calcium if the albumin level is known. [citation needed]
To calculate a corrected calcium in mmol/L one takes the total calcium in mmol/L and adds it to ((40 minus the serum albumin in g/L) multiplied by 0.02). [33] There is, however, controversy around the usefulness of corrected calcium as it may be no better than total calcium. [34]
Calcium regulation in the human body. [6]The plasma ionized calcium concentration is regulated within narrow limits (1.3–1.5 mmol/L). This is achieved by both the parafollicular cells of the thyroid gland, and the parathyroid glands constantly sensing (i.e. measuring) the concentration of calcium ions in the blood flowing through them.
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Diagnosis should generally include either a calculation of corrected calcium or direct measurement of ionized calcium level and be confirmed after a week. [1] This is because either high or low serum albumin levels does not show the true levels of ionised calcium. [15]
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