Objective:

To highlight the limitations of albumin-adjusted calcium and advocate for the use of ionised calcium, emphasizing its clinical advantages.

Approach:

Key Findings:

• Albumin-adjusted calcium is unreliable in elderly, critically ill, and renally impaired patients.
• pH and protein disturbances can undermine correction formulas for adjusted calcium.
• Universal reporting of albumin-adjusted calcium can lead to misdiagnosis of hypo- or hypercalcaemia.
• The concept of 'corrected calcium' has been challenged since the 1970s, with evidence accumulating against its use.

Interpretation:

Accumulating evidence suggests that ionised calcium should replace albumin-adjusted calcium in clinical practice due to its reliability in various patient populations.

Limitations:

• Continued use of albumin-adjusted calcium despite known limitations can lead to misdiagnosis and inappropriate treatment.
• Potential for misdiagnosis due to reliance on outdated correction formulas, impacting patient outcomes.

Conclusion:

Clinicians should be aware of the limitations of albumin-adjusted calcium and consider ionised calcium as a preferred alternative, implementing this change in practice.

Sources:

• Pathology
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