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A corrected calcium level based on the albumin level is: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 * (4.0 - serum albumin [g/dL]). [20] Since calcium is also bound to small anions, it may be more useful to correct total calcium for both albumin and the anion gap. [21] [22]
Diagram showing the basic physiologic mechanisms of the kidney. The renal clearance ratio or fractional excretion is a relative measure of the speed at which a constituent of urine passes through the kidneys.
To calculate a corrected calcium in mmol/L one takes the total calcium in mmol/L and adds it to ((40 minus the serum albumin in g/L) multiplied by 0.02). [33] There is, however, controversy around the usefulness of corrected calcium as it may be no better than total calcium. [34] It may be more useful to correct total calcium for both albumin ...
In the largest study published to date, featuring over 12,000 data sets, Figge, Bellomo and Egi [18] demonstrated that the anion gap, when used to detect critical levels of lactate (greater than 4 mEq/L), exhibited a sensitivity of only 70.4%. In contrast, the albumin-corrected anion gap demonstrated a sensitivity of 93.0%.
In nephrology, the delta ratio, or "delta-delta" (denoted Δ/Δ), is a formula that can be used to evaluate whether a mixed acid–base disorder (metabolic acidosis) is present, and if so, assess its severity.
The amount of biologically active calcium varies with the level of serum albumin, a protein to which calcium is bound, and therefore levels of ionized calcium are better measures than a total calcium; however, one can correct a total calcium if the albumin level is known. [citation needed]
The plasma total calcium concentration is in the range of 2.2–2.6 mmol/L (9–10.5 mg/dL), and the normal ionized calcium is 1.3–1.5 mmol/L (4.5–5.6 mg/dL). [4] The amount of total calcium in the blood varies with the level of plasma albumin, the most abundant protein in plasma, and therefore the main carrier of protein-bound calcium in the blood.
Hypocalcemia is a low blood calcium level. A total serum calcium of less than 8 mg/dL (2mmol/L) or ionized calcium less than 1.2 mmol/L in term neonates is defined as hypocalcemia. In preterm infants, it is defined as less than 7mg/dL (1.75 mmol/L) total serum calcium or less than 4mg/dL (1 mmol/L) ionized calcium.