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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 ]
The plasma total calcium concentration is in the range of 2.2–2.6 mmol/L (9–10.5 mg/dL), and the normal ionized calcium is 1.3–1.5 mmol/L (4.5–5.6 mg/dL). [4] The amount of total calcium in the blood varies with the level of plasma albumin, the most abundant protein in plasma, and therefore the main carrier of protein-bound calcium in the blood.
A reference range is usually defined as the set of values 95 percent of the normal population falls within (that is, 95% prediction interval). [2] It is determined by collecting data from vast numbers of laboratory tests.
Total body water in healthy adults is about 50–60% (range 45 to 75%) of total body weight; [1] women and the obese typically have a lower percentage than lean men. [2] Extracellular fluid makes up about one-third of body fluid, the remaining two-thirds is intracellular fluid within cells. [3]
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]
The standard definition of a reference range for a particular measurement is defined as the interval between which 95% of values of a reference population fall into, in such a way that 2.5% of the time a value will be less than the lower limit of this interval, and 2.5% of the time it will be larger than the upper limit of this interval, whatever the distribution of these values.
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] It may be more useful to correct total calcium for both albumin ...
To prevent low bone density it is recommended to have sufficient calcium and vitamin D. [17] [18] Sufficient calcium is defined as 1,000 mg per day, increasing to 1,200 mg for women above 50 and men above 70. [18] Sufficient vitamin D is defined as 600 IUs per day for adults 19 to 70, increasing to 800 IUs per day for those over 71. [18]