Abstract
One quarter of 172 patients from two hospitals with no obvious disturbances of calcium homeostasis and with total serum calcium concentrations that were normal after adjustment for albumin concentration had low serum ionised calcium concentrations. The low values were not due to changes in pH but were associated with hypoalbuminaemia. Significant positive regressions of ionised calcium on albumin concentration were observed in patients from both hospitals and also in 48 healthy laboratory staff. Because the regressions did not differ between patients and healthy subjects the low ionised calcium values associated with hypoalbuminaemia are unlikely to have been of pathological importance. These findings indicate that interpreting serum ionised calcium concentrations in patients with a reduced serum albumin concentration on the basis of a reference range determined in subjects with a normal serum albumin concentration may be clinically misleading.