It is essential that a critical finding be communicated immediately to the requesting health-care provider (HCP). Note and immediately report to the health-care provider (HCP) any critically increased or decreased values and related symptoms.
Greater than 6.2 mg/dL (SI: Greater than 1.6 mmol/L). Less than 3.2 mg/dL (SI: Less than 0.8 mmol/L). Vitamin D toxicity (related to increased absorption of calcium)īurns, severe (related to increased amino acid release) Hypoparathyroidism (primary) (related to decreased PTH) Magnesium deficiency (inhibits release of PTH) Multiple organ failure Pancreatitis (associated with saponification or binding of calcium to fats in tissue surrounding the pancreas) The postdialysis period (result of low-calcium dialysate administration) The postsurgical period (i.e., major surgeries) (related to decreased PTH) The post-transfusion period (result of the use of citrated blood product preservative ) Premature infants with hypoproteinemia and acidosis (related to alterations in transport protein levels) Pseudohypoparathyroidism (related to decreased PTH) Sepsis (related to decreased PTH) Trauma (related to decreased PTH) Vitamin D deficiency (related to decreased absorption of calcium) Critical findings. PTH-producing neoplasms (PTH increases calcium levels). Hyperparathyroidism (related to increased PTH). Monitor patients with sepsis or magnesium deficiency. Monitor patients with renal failure or organ transplantation in whom secondary hyperparathyroidism may be a complication. Investigate suspected hyperparathyroidism. Identify individuals with toxic levels of vitamin D. Evaluate the effect of protein on calcium levels. Detect ectopic parathyroid hormone (PTH)–producing neoplasms. It is also useful in the evaluation of patients in cardiac arrest. Measurement of ionized calcium is useful to monitor patients undergoing cardiothoracic surgery or organ transplantation. 
Elevations in ionized calcium may be seen when the total calcium is normal. Levels are also not affected in patients with metabolic acid-base balance disturbances. Ionized calcium levels are not influenced by protein concentrations, as seen in patients with hypoalbuminemia, chronic renal failure, nephrotic syndrome, malabsorption, and multiple myeloma. Compared to total calcium level, ionized calcium is a better measurement of calcium metabolism. Vitamin D enhances GI absorption of calcium. Calcium levels are regulated largely by the parathyroid glands and by vitamin D calcium levels are inversely proportional to PTH levels.
#Unbound synonym free
About half of the total amount of calcium circulates as free ions that participate in blood coagulation, neuromuscular conduction, intracellular regulation, glandular secretion, and control of skeletal and cardiac muscle contractility. Ionized calcium is the physiologically active form of circulating calcium. Circulating calcium is found in the free or ionized form bound to organic anions such as lactate, phosphate, or citrate and bound to proteins such as albumin. Calcium, the most abundant cation in the body, participates in almost all of the body’s vital processes (see other calcium studies).
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