Adjusted Calcium Is Lying — And Labs Keep Printing It
Choy et al. argue it's time to stop trusting a number that's been unreliable for fifty years.
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By
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Kerri Miller
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March 18, 2026
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Clinical Scorecard: Adjusted Calcium Is Lying — And Labs Keep Printing It
At a Glance
| Category | Detail |
|---|
| Condition | Calcium Imbalance Assessment |
| Key Mechanisms | Limitations of albumin-adjusted calcium in various patient populations. |
| Target Population | Elderly, critically ill, and renally impaired patients. |
| Care Setting | Clinical laboratories and patient care settings. |
Key Highlights
- Albumin-adjusted calcium is widely used despite limitations.
- Unreliable in specific populations due to pH and protein disturbances.
- Universal provision can lead to misdiagnosis of calcium imbalances.
- Evidence supports replacing adjusted calcium with ionised calcium.
- The concept of corrected calcium has been challenged since the 1970s.
Guideline-Based Recommendations
Diagnosis
- Avoid reliance on albumin-adjusted calcium for diagnosing hypo- or hypercalcaemia.
Management
- Consider using ionised calcium as the preferred method for calcium assessment.
Monitoring & Follow-up
- Be aware of the limitations of albumin-adjusted calcium in patient monitoring.
Risks
- Misdiagnosis and inappropriate treatment due to reliance on adjusted calcium.
Patient & Prescribing Data
Patients with calcium imbalances, particularly those with complicating factors.
Shift towards ionised calcium measurement for accurate assessment.
Clinical Best Practices
- Educate clinicians on the limitations of albumin-adjusted calcium.
- Implement ionised calcium testing as a standard practice.
- Regularly review and update laboratory protocols regarding calcium assessment.
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