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Doctor insights on: Serum Ionized Calcium

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Dr. David Sneid
Board Certified, Endocrinology
35 years in practice
38M people helped
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1
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. ...Read more

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Dr. Vicken Poochikian
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36 years in practice
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Dr. Mark Pack
32 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


Dr. Alan Feldman
Board Certified, Endocrinology
35 years in practice
2M people helped
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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. ...Read more

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Dr. Vicken Poochikian
Board Certified
36 years in practice
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Dr. Vered Lewy-Weiss
Board Certified, Pediatric Endocrinology
22 years in practice
11M people helped
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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. Su Fairchild
Board Certified, Integrative Medicine
18 years in practice
4M people helped
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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. Vicken Poochikian
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Dr. Michael Taylor
Board Certified, Critical Care
16 years in practice
135K people helped
5

5
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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Dr. Michael Yap
Board Certified, Nephrology and Dialysis
8 years in practice
237K people helped
6

6
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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Dr. William Culviner
Board Certified, ENT and Head and Neck Surgery
24 years in practice
1M people helped
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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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Dr. Thomas Knecht
Board Certified, Endocrinology
25 years in practice
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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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Dr. Ed Friedlander
Board Certified, Pathology
38 years in practice
136M people helped
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9
Female 26- calcium 10.5 ionized calcium 1.34, is that normal?

Female 26- calcium 10.5 ionized calcium 1.34, is that normal?

Just watch it: This is at the upper limit of normal for most reference ranges, and these in turn are set up so that several percent of healthy people will fall on either side. Watch and see what it's like on your next routine set of labs unless you develop symptoms. ...Read more

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Dr. Robert Uyeda
Board Certified, General Surgery
39 years in practice
5M people helped
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What does an elevated or low ionized calcium results mean?

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. ...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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Dr. Vicken Poochikian
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