Calcium, Ionized, Serum
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Ionized calcium, which accounts for 50% to 55% of total calcium, is the physiologically active form of calcium.
Low ionized calcium values are often seen in renal disease, critically ill patients, or patients receiving rapid transfusion of citrated whole blood or blood products.
Increased serum ionized calcium concentrations may be seen with primary hyperparathyroidism, ectopic parathyroid hormone-producing tumors, excess intake of vitamin D, or various malignancies.
Nomograms have been used to calculate ionized calcium from total calcium, albumin, and pH values. However, calculated ionized calcium results have proven to be unsatisfactory. (A Mayo study of 114 patients found significant differences between ionized and total calcium in 26% of patients.)
Assessing calcium states during liver transplantation surgery, cardiopulmonary bypass, or any procedure requiring rapid transfusion of whole blood in neonates and in critically ill patients
Second order test in the evaluation of patients with abnormal calcium values
Serum ionized calcium concentrations 50% below normal result in severely reduced cardiac stroke work. With moderate to severe hypocalcemia, left ventricular function may be profoundly depressed.
Ionized calcium values are higher in children and young adults.
Ionized calcium values vary inversely with pH, approximately 0.2 mg/dL per 0.1 pH unit change.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Proper specimen handling is necessary to ensure accurate results.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
<1 year: not established
1-19 years: 4.90-5.50 mg/dL
> or =20 years: 4.65-5.30 mg/dL
<1 year: not established
1-17 years: 4.90-5.50 mg/dL
> or =18 years: 4.65-5.30 mg/dL
Clinical References Provides recommendations for further in-depth reading of a clinical nature
1. Toffaletti JG: A clinical review of ionized calcium: a better indicator than total calcium. Waltham, MA, Nova Biomedical, 1998
2. Tietz: Textbook of Clinical Chemistry and Molecular Diagnostics, Fourth Edition, 2006. Measurement of free (ionized) Calcium; Effect of PH & Anticoagulant.