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Doctor insights on: Ionized Calcium Vs Serum Calcium

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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. ...Read more

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Dr. Rashed Hasan
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Dr. James Chapman
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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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A low vitamin d=10.1mg/ml, calcium serum =10.9 mg/dl.Pth=31pg/ml and ionized calcium serum=5.1mg/dl is it normal?Doctor gave me 50, 000 units of vit

A low vitamin d=10.1mg/ml, calcium serum =10.9 mg/dl.Pth=31pg/ml and ionized calcium serum=5.1mg/dl  is it normal?Doctor gave me 50, 000 units of vit

D3: D3 is preferred over d2 as it is less toxic and more bioavailable. Aim for serum level of d to be about 60. I would dose you at 10000 iu d3 daily for 2 weeks then 5000 iu daily, and also encourage 5-15 mins of sun exposure daily. Recheck d level in 2-3 months. ...Read more

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Dr. Rashed Hasan
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Is there a difference between a calcium vs. Ionized calcium test?

Is there a difference between a calcium vs. Ionized calcium test?

Yes: Calcium has a positive electrical charge; many proteins have a negative electrical charge. So, the opposite charges can cause calcium can bind to proteins. The test for serum calcium measures all of the calcium in the blood (bound & unbound). The ionized calcium measures just the unbound. ...Read more

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What is the true measure of hypocalcemia? Low ionized calcium, or low calcium? Thank you.

What is the true measure of hypocalcemia? Low ionized calcium, or low calcium? Thank you.

Depends on context: More information is needed, especially in regards to a correction factor against the serum albumin in hypocalcemia. Ionized calcium is a good measure too, but again, context is necessary. Please see your doctor to help you with clinical context of laboratory values, because the values are not really significant until they are applied to your clinical situation. ...Read more

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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. ...Read more

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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. ...Read more

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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. ...Read more

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What is the definition or description of: ionized calcium?

What is the definition or description of: ionized calcium?

Unbound calcium: 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 because Albumin is low. ...Read more

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What's the difference between low ionized calcium and low calcium? Which one is the true measure of hypocalcemia?

What's the difference between low ionized calcium and low calcium? Which one is the true measure of hypocalcemia?

Both: If you can measure (rarely done), calculate (complicated formula) or estimate (calcium minus albumin), you will get the ionized calcium. About half of the calcium in the blood is ionized and this is the active form. In real-life, this means that a lot of sick people with low albumin also have low total calcium but needn't worry as the physiologic ionized calcium is what's regulated. ...Read more

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What can prolonged low ionized calcium in the blood do to one's body? How dangerous is it?

What can prolonged low ionized calcium in the blood do to one's body? How dangerous is it?

It's not good: low calcium levels cause a lot of problems, and can eventually be extremely serious. You might notice twitching and spasms or cramps. ...Read more

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Serum (Definition)

Serum is the component of blood that does not contain cells or clotting factors. It does contain electrolytes an ...Read more


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