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How can the serum total calcium be increased, yet the serum ionized calcium is normal?

April 26, 2017calcium increased ionized normal serum total

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How can the serum total calcium be increased, yet the serum ionized calcium is normal?

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This most commonly occurs in patients with chronic renal failure. Serum total calcium is composed of three fractions: ionized, complexed, and protein-bound. Alterations in any one of the fractions can impact total calcium concentration. An increase in the complexed fraction of calcium has been documented in chronic renal failure patients which results in an elevated total calcium, with a normal serum ionized calcium. Hypercalcemia should not be treated in these cases, since ionized calcium is normal (and may be low). Reference: Schenck, P.A. and Chew, D.J. 2003. Calcium fractionation in dogs with chronic renal failure. Am. J. Vet. Res. 64: 1181-1184.