Gastrin levels were normal, calcitonin values were uniformly below the detection limit of the assay, and pancreatic glucagon levels were elevated. Total calcium showed similar changes with nadirs at 2 h of 1.84, 2.05, and 2.22 mmol/L. Measurement of ionized blood calcium: Ionized calcium (iCa) is different from total calcium in that the former is considered the active form of calcium in the body. Normal value ranges may vary slightly among different laboratories. Your blood calcium level would be considered high if it surpasses the upper limit of the normal range, meaning it is greater than 10.3 mg/dl. Lower Levels. i have bone pain, fatigue, kidney stones. Lower levels of ionized calcium may indicate hypoparathyroidism while lower levels of serum calcium may indicate hypocalcemia. People with abnormal calcium levels may not have any symptoms. This range can vary from lab to lab. The normal range for calcium levels in adults is around 8.5 to 10.5 mg/dL. In these clinical situations, total calcium is often difficult to interpret or misleading due to decreased albumin and other proteins, acid-base disturbances, and transfusion of citrated blood. This notion is supported by the fact that with the diet deficient in calcium and vitamin D, only rats able to maintain ionized calcium at a level >4.0 mg/dl had “close to normal” FGF23 levels. However, it is important to re-check your calcium levels after receiving one elevated blood calcium result to confirm high calcium, otherwise called hypercalcemia. Parathyroid hormone levels were high, and there was a significant inverse correlation with ionized calcium. Further blood tests for ionized calcium levels and to check for ethylene glycol in case of toxicity may be necessary. Ideally, an ionized calcium level should be performed as it is more specific and more accurate. Total and ionized calcium levels were either low or in the low-normal range as were phosphorus and total magnesium levels. Calcium ions (Ca 2+) contribute to the physiology and biochemistry of organisms cell.They play an important role in signal transduction pathways, where they act as a second messenger, in neurotransmitter release from neurons, in contraction of all muscle cell types, and in fertilization.Many enzymes require calcium ions as a cofactor, including several of the coagulation factors. The level of ionized calcium in the blood is not affected by the amount of protein in the blood. Parathyroid hormone and vitamin D regulate normal plasma calcium levels by their actions on kidney, intestine, and bone ion transport. Total and ionized blood calcium levels can change differently depending on the underlying disease process. Ionized calcium level was a more sensitive indicator of PHPT because there was a greater incidence of ionized calcium being elevated without concordant serum calcium elevation than vice versa (P < .0001). Many other clinical issues need to be examined (bone density, urine calcium, variability of the labs, etc). Ionized calcium levels are often estimated based on total blood calcium and albumin levels. Blood calcium levels do not indicate levels of bone calcium but rather how much calcium is circulating in the blood. The examples above show the common measurements for results for these tests. Free calcium level decreases in your blood upon an increase in protein binding which can be a result of increase in pH and alkalosis of blood. Since the CKD and ESRD population is undoubtedly much older than the reference population, adherence to stated normal ranges will result in ionized calcium levels that are above normal in some patients. Normal calcium The normal level of ionized calcium is 4.64 to 5.28 mg/dL in adults while the normal level of serum calcium is 8.6 and 10 mg/dL. The normal range is also not corrected for acidosis, which is invariably present in the predialysis samples routinely ob- tained in hemodialysis patients. Most people do not experience any of these symptoms until their calcium levels are extremely out of range, so the test results may be very dramatic. Bone and kidney radiographs – Smaller than normal kidney may indicate chronic kidney failure, enlarged acute kidney failure or toxicity especially glycol and oxalate. The level of ionized calcium in the blood is not affected by the amount of protein in the blood. Plasma ionized calcium is the biologically active moiety. Ionized calcium is valuable in establishing a diagnosis of hyperparathyroidism, especially in borderline cases where total calcium levels may be normal but ionized calcium increased. Ionized calcium levels are typically normal in patients with both decreased serum albumin and total calcium levels. Corrected calcium (mg/dL) = measured total Ca 2+ (mg/dL) + [0.8 x (4.0 - albumin concentration in g/dL)] Increased ionized calcium, regardless of total calcium levels → true hypercalcemia (potentially symptomatic) Increased total calcium with normal ionized (active) calcium → factitious hypercalcemia (asymptomatic finding) An ionized calcium level is slightly more difficult to measure, and is only readily available as a send out test or at most specialty clinics or emergency clinics. There shouldn’t be any of the ethylene glycols in blood. Normal Values. You may need to have a separate ionized calcium test if you have factors that increase or decrease total calcium levels. Talk to your doctor about the meaning of your specific test results. Low ionized calcium values are often seen in renal disease, critically ill patients, or patients receiving rapid transfusion of citrated whole blood or blood products. 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