What is hypercalcemia? The importance of fasting samples
Fadi F Siyam1, David M Klachko1
1Cosmopolitan International Diabetes and Endocrinology Center, University of Missouri Health Sciences Center, Columbia, Mo., USA ; Harry S. Truman Memorial VA Hospital, Columbia, Mo., USA.
Cardiorenal Medicine
|January 30, 2014
Summary
Accurate hypercalcemia diagnosis requires measuring ionized calcium, not just total calcium. Repeat fasting ionized calcium tests are recommended for elevated total calcium to avoid misdiagnosis.
Area of Science:
- Endocrinology
- Clinical Chemistry
Background:
- Differentiating hyperparathyroidism subtypes necessitates accurate hypercalcemia identification.
- Blood calcium exists in bound, complexed, and ionized fractions, with parathyroid cells sensing only the ionized form.
Purpose of the Study:
- To evaluate the diagnostic accuracy of total versus ionized calcium measurements.
- To provide recommendations for the accurate diagnosis of hypercalcemia.
Main Methods:
- Analysis of factors affecting total and ionized calcium levels.
- Review of existing formulas for calcium correction.
- Clinical condition assessment impacting calcium levels.
Main Results:
- Formulas adjusting total calcium for ionized calcium have limited accuracy and can introduce errors.
- Factors like acid-base balance, sample collection, exercise, and calcium intake influence calcium levels.
- Fasting ionized calcium is superior to total calcium for diagnostic purposes.
Conclusions:
- Fasting ionized calcium levels are crucial for accurate hypercalcemia diagnosis.
- Repeat fasting total and ionized calcium measurements are recommended for isolated high total calcium.
- Hypercalcemia diagnosis requires persistent or frequent elevated ionized calcium levels.
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