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Doctor insights on: High Ionized Calcium Levels

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Why r my calcium levels normal, while my ionized calcium levels are high? I have bone pain, fatigue, kidney stones. I don't know pth level, or vit. D.

Why r my calcium levels normal, while my ionized calcium levels are high? I have bone pain, fatigue, kidney stones. I don't know pth level, or vit. D.

Half if calcium: In the blood is bound to proteins and inactive. The other, active, half is the ionized or free calcium, which is what really does the heavy lifting and is more accurate cllinically. You really need the other lab and a good endocrinologist.

Dr. Dariush Saghafi
37 Doctors shared insights

Ionized Calcium (Definition)

Most calcium in the blood is bound to a molecule called albumin, and this calcium fluctuates depending on the level of albumin. The rest is "ionized" calcium and this is freely available for biologic processes. Labs used to only be able to measure total calcium - calcium bound to Albumin + ionized. Now we can measure ionized calcium and not be mislead that calcium is low ...Read more


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Ionized Calcium 4.65, PTH 133, Calcium 10.3, Vitamin D 7, Phosphorus 4.9, recurrent Kidney stones. Thyroid lobe, two parathyroids removed in 2004.

Ionized Calcium 4.65, PTH 133, Calcium 10.3, Vitamin D 7, Phosphorus 4.9, recurrent Kidney stones. Thyroid lobe, two parathyroids removed in 2004.

Uncertain: These test results don't add up to a straight forward answer. However, I would be concerned about the possibility of recurrent primary hyperparathyroidism. You should take Vit D to eliminate Vit D deficiency as a cause for high PTH levels. Once this is done, if you still have high PTH with high calcium levels, you have recurrent primary HPTH and will need surgery again.

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What are common causes of normal calcium serum levels with high ionized calcium levels?

What are common causes of normal calcium serum levels with high ionized calcium levels?

Albumin deficiency: Total calcium is attached to albumin, an important protein in the blood. Your serum calcium may be erroneously normal if your ionized calcium is significantly elevated, look at Albumin level and also repeat the calcium tests to make sure no mistake. May need to look at mg, phos, and intact pth.

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Should I take CALCITROL even if my INTACT PTH is just slightly elevated and my IONIZED CALCIUM is just slightly below the normal levels?

Should I take CALCITROL even if my INTACT PTH is just slightly elevated and my IONIZED CALCIUM is just slightly below the normal levels?

Not necessarily: Hi. For your calcium and PTH, you should only take calcitriol if calcitriol deficiency is the cause of the lab abnormality! And that would be unlikely in a person who's kidney function is normal. If vitamin D deficiency is the cause, you just take vitamin D, NOT the hormonally active form of vitamin D, calcitriol. We don't know the details of your case, so naturally can't tell you what you need.

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Is there no cure to low ionized calcium and high intact pth? My creatinine level is within the normal level. What's the cure to this?

Is there no cure to low ionized calcium and high intact pth? My creatinine level is within the normal level. What's the cure to this?

Things to check: Hi. I would recommend checking 25-hydroxyvitamin D, 1, 25-dihydroxyvitamin D, and 24-hour urine for calcium and creatinine. If indicated, get worked up for intestinal malabsorption. Your secondary hyperparathyroidism is a physiologic response of the parathyroids to a threat of low blood calcium.

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Why r my calcium levels normal, while my ionized calcium levels are high? I have bone pain, fatigue, kidney stones. I don't know pth level, or vit. D.

Half if calcium: In the blood is bound to proteins and inactive. The other, active, half is the ionized or free calcium, which is what really does the heavy lifting and is more accurate cllinically. You really need the other lab and a good endocrinologist.

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If you have high ionized calcium, are you considered hypercalcemic?

If you have high ionized calcium, are you considered hypercalcemic?

Many causes: Many causes, can raise calcium....You really need a doctor to evaluate the possibilities.

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What does an elevated or low ionized calcium results mean?

Ionized calcium: Measurement is more accurate than total calcium because it measures the amount of calcium in the blood that is actually available for cellular metabolism. Many possibilities for causes and consequences of low or high calcium, too many to list here. Ask your doctor to interpret your results for you.

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What does it mean when my IONIZED CALCIUM is LOW and my INTACT PTH is high? What's the cure to this alarming result? Please help. Thanks.

What does it mean when my IONIZED CALCIUM is LOW and my INTACT PTH is high? What's the cure to this alarming result? Please help. Thanks.

Low Ca highPTH: Calcium in our blood circulates in two forms. Bound to albumin. Unbound =ionized. Low ionized Calcium is low unbound calcium. It is abnormal. And low ionized calcium will trigger PTH secretoon to higher levels. Remedy requires figuring out why and fixing root cause. Meanwhile, under guidance, take vitamin D 2000 iu daily and 1000 mg calciun as calcium citrate. Is your kidney function normal?

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What triggers the INTACT PTH to become high? Is it the low calcium? Or what triggers having low ionized calcium, is it the high INTACT PTH?

What triggers the INTACT PTH to become high? Is it the low calcium? Or what triggers having low ionized calcium, is it the high INTACT PTH?

Several reasons: There are several triggers to high PTH, and you will need to see your doc for workup. Some things that can do this are of primary cause (happens on its own i.e. adenoma), low vitamin D levels, somewhat advanced chronic kidney disease, low calcium levels. As always, labs are just labs, but the clinical context is where the importance lies. Please follow up with your doc about this.

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With my slightly below normal IONIZED CALCIUM and slightly elevated INTACT PTH, is it beneficial to take 1 tablet of CALCIDAY once a day?

With my slightly below normal IONIZED CALCIUM and slightly elevated INTACT PTH, is it beneficial to take 1 tablet of CALCIDAY once a day?

Calcium: You should be taking in at least 1000 mg of calcium per day. Much of calcium is not absorbed. It may be important to determine whether you have a problem with calcium absorption. Vit D deficiency will do this. See your doctor about your Vit D level.

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Can we say that if a person has low IONIZED CALCIUM and high INTACT PTH, that person has already kidney disease?

Can we say that if a person has low IONIZED CALCIUM and high INTACT PTH, that person has already kidney disease?

No: Kidney disease diagnosis requires many more criteria. PTH is only one seen in advanced kidney disease. It is raised on other conditions too.

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Now that my IONIZED CALCIUM is low and my INTACT PTH is high, does it mean or does it confirm that I have kidney disease?

Not diagnostic: Hi. Low ionized calcium and high PTH (a condition called secondary hyperparathyroidism) is in no way diagnostic of kidney disease. Secondary hyperparathyroidism may be seen in kidney disease. Kidney disease is usually diagnosed by an elevated serum creatinine and sometimes by other things like protein or blood in the urine. There are common non-kidney causes of secondary hyperparathyroidism.

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What is calcitriol for? Is this a dangerous drug? Can it cure low IONIZED CALCIUM and HIGH INTACT PTH? Or simple calcium carbonate is ok?

What is calcitriol for? Is this a dangerous drug? Can it cure low IONIZED CALCIUM and HIGH INTACT PTH? Or simple calcium carbonate is ok?

Active vitamin D: Hi. Calcitriol is the active hormone form of vitamin D. If you are vitamin D deficient, it will make up the loss. However, if your kidneys work and you have normal PTH function, you will make your own calcitriol by just taking over the counter vitamin D and letting your own body make the calcitriol. I've seen your case on here. Isn't your doctor explaining ANYTHING to you? They owe you explanation

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Low vitamin D - 7 High parathyroid- 133 Recurrent kidney stones Low normal ionized calcium 4.65 Calcium 10.3 Are kidney stones due to low vitamin D?

Low vitamin D - 7 High parathyroid- 133 Recurrent kidney stones Low normal ionized calcium 4.65 Calcium 10.3 Are kidney stones due to low vitamin D?

No: Hi. Nope, stones NOT due to low vitamin D. You should do an accurate 24-hour urine for creatinine (for validation), calcium, oxalate, citrate, phosphate, and sodium; UA for urine pH. Your total calcium looks a tad high; confirm total calcium and albumin, and ionized calcium. You should see an experienced endocrinologist or nephrologist for a thorough evaluation. Good luck!

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I have consistently elevated ionized calcium, low D, osteopenia & idiopathic chronic pancreatitis. Hyperaparathyroidism a possibility?

I have consistently elevated ionized calcium, low D, osteopenia & idiopathic chronic pancreatitis. Hyperaparathyroidism a possibility?

Calcium, D, Hyperpar: Surely your doctor has measured your parathyroid hormone level. You must see both an Endocrinologist and a Gastroenterologist. PS: Osteopenia is not a very worrying condition.

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My IONIZED CALCIUM is slightly low and my INTABT PTH is slightly elevated. My 24-hr Urine Ca is 105.64 and the normal is 100-240. Problem?

My IONIZED CALCIUM is slightly low and my INTABT PTH is slightly elevated. My 24-hr Urine Ca is 105.64 and the normal is 100-240. Problem?

Calcium homeostasis: It depends on the exact numbers, but a slightly low calcium with a slightly elevated PTH is contradictory. If PTH is elevated, your serum calcium should be high. Your urine calcium is normal. Overall, there does not appear to be a problem. You should be seeing an endocrinologist to put it all together. There is not enough information to give you more guidance.

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Does low ionized calcium level in the blood mean having kidney disease? Please explain.

Does low ionized calcium level in the blood mean having kidney disease? Please explain.

Not necessarily: There are other more common causes, like Vitamin D deficiency. Typically if someone has checked your calcium they have also checked your kidney function (specifically creatinine), so if you are worried about your kidneys you could ask your doctor.