Calcium Correction for Hypoalbuminemia

Adjust serum calcium in the setting of low albumin


Measured total calcium in serum consists of about 15% bound to organic and inorganic anions, about 40% bound to albumin, and the remaining as biologically active ionized calcium.

Therefore, serum total calcium may underestimate biologically active calcium levels in the hypoalbuminemic patient.

The adjustment formula is as follows:

  • Corrected Calcium mg/dL = (0.8 * (Normal Albumin - Pt's Albumin)) + Serum Ca
  • Corrected Calcium mmol/L = (0.02 * (Normal Albumin - Pt's Albumin)) + Serum Ca;

Please note that this adjustment formula has been shown to inaccurate in patients with chronic kidney disease and end-stage renal disease


Payne RB, Little AJ, Williams RB, Milner JR.

British Medical Journal (1857-1980) 1973 December 15, 4 (5893): 643-6

Gauci C1, Moranne O, Fouqueray B, de la Faille R, Maruani G, Haymann JP, Jacquot C, Boffa JJ, Flamant M, Rossert J, Urena P, Stengel B, Souberbielle JC, Froissart M, Houillier P.

Journal of the American Society of Nephrology: JASN 2008, 19 (8): 1592-8

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1. Serum calcium (total)?

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