Categories: Endocrinology

Why do you order Albumin with Calcium?

Total Calcium needs to be interpreted in the context of serum albumin levels 

WHY? Calcium is protein bound (primarily to Albumin). Hence in states of low or high albumin, the total Calcium level may not reflect the amount of ionized (free) Ca2+; which is the form that is physiologically active.

There are two formulas:

SI: Calcium (corrected) = Serum Calcium + 0.025 x (Normal albumin – Patient albumin) [sometimes the 0.025 will be approximated as 0.02]

*Normal albumin is typically 40g/L or 44g/L for most hospitals (US: 4g/dL or 4.4 g/dL)

US: Calcium (corrected) = Serum Calcium + 0.8 x (Normal albumin – Patient albumin)

Rule of Thumb: For every drop in 10g/L of Albumin, your total Calcium will increase by 0.2mmol/L (or 0.8 mg/dL)

NOTE: Evidence exists that the Payne correction formula does not correlate well with Ionized-Ca2+.

References

  1. Payne RB, Little AJ, Williams RB, Milner JR. Interpretation of serum calcium in patients with abnormal serum proteins. Br Med J. 1973 Dec 15;4(5893):643-6.
Get Medical Pearls directly to your inbox every week!
Weekly posts with high yield medical knowledge, directly to your mailbox!
Dr. C Humphreys

Internal Medicine

Recent Posts

Older Age and Obstructive Sleep Apnea (OSA): Mechanism

Older age is recognized as a risk factor for obstructive sleep apnea.[1] But why? Suspected…

1 month ago

How does Weight Affect Obstructive Sleep Apnea (OSA): Mechanism

Being overweight (BMI ≥ 25 kg/m2)/Obese (BMI ≥ 30 kg/m2) is one of the most…

1 month ago

Nocturia and OSA: Mechanism

Nocturia is a common symptom associated with obstructive sleep apnea. [1] Img Cred: Am J…

1 year ago

ASD vs. VSD Murmur Difference

ASD (Atrial Septal Defect) Wide, Fixed split S2 (in contrast to the normal variation in…

1 year ago

Mechanism of a Mixed Apnea

Mixed apneas are characterized by absent respiratory effort and airflow in the first section of…

2 years ago

How Does Hypothyroidism Cause Hypoventilation?

Although rare, the differential diagnosis of hypoventilation and hypercapnia respiratory failure includes hypothyroidism. It is…

2 years ago

This website uses cookies.