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  • Title: Albumin-adjusted calcium is not suitable for diagnosis of hyper- and hypocalcemia in the critically ill.
    Author: Slomp J, van der Voort PH, Gerritsen RT, Berk JA, Bakker AJ.
    Journal: Crit Care Med; 2003 May; 31(5):1389-93. PubMed ID: 12771607.
    Abstract:
    OBJECTIVE: To evaluate whether calcium adjusted for albumin can be used to monitor calcium homeostasis in critically ill patients. DESIGN: Prospective single-single center observational study. SETTING: Clinical laboratory and critical care unit of a regional teaching hospital. PATIENTS: Fifty-three paired samples were from 36 patients requiring intensive care treatment. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Total calcium, albumin-adjusted calcium, and ionized calcium were measured in critically ill patients during an 8-wk period. Calcium was adjusted for albumin using the formula that is most frequently used in The Netherlands. Using ionized calcium as the gold standard, albumin-adjusted calcium overestimated hypercalcemia and totally missed hypocalcemia. The same seemed to be true for other formulas used for albumin or protein adjustment of calcium concentrations. CONCLUSIONS: Albumin-adjusted calcium cannot be used in an intensive care setting to monitor reliably the calcium levels in critically ill patients and should be replaced by measurement of ionized calcium.
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