DOI: 10.1097/01.CCM.0000063044.55669.3C

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PMID: 12771607

Issn Print: 0090-3493

Publication Date: 2003/05/01


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Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill

Jennichjen Slomp; Peter H. J. van der Voort; Rik Th. Gerritsen; Jan A. M. Berk; Andries J. Bakker

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Abstract

Objective

To evaluate whether calcium adjusted for albumin can be used to monitor calcium homeostasis in critically ill patients.

Design

Prospective single-single center observational study.

Setting

Clinical laboratory and critical care unit of a regional teaching hospital.

Patients

Fifty-three paired samples were from 36 patients requiring intensive care treatment.

Interventions

None.

Measurements and Main Results

Total calcium, albumin-adjusted calcium, and ionized calcium were measured in critically ill patients during an 8-wk period. Calcium was adjusted for albumin using the formula that is most frequently used in The Netherlands. Using ionized calcium as the gold standard, albumin-adjusted calcium overestimated hypercalcemia and totally missed hypocalcemia. The same seemed to be true for other formulas used for albumin or protein adjustment of calcium concentrations.

Conclusions

Albumin-adjusted calcium cannot be used in an intensive care setting to monitor reliably the calcium levels in critically ill patients and should be replaced by measurement of ionized calcium.

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