Ionised Calcium
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Evaluates serum calcium, essential for bones, muscle function, nerve signaling, and cardiac health.
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🧪 What is Ionised Calcium?
Ionised calcium (also called free calcium) is the biologically active form of calcium in the blood. Unlike total calcium, it is not bound to proteins like albumin and directly participates in:
- Muscle contractions
- Nerve signaling
- Blood clotting
- Hormone release
- Bone health
It represents about 45–50% of total serum calcium and is a more accurate indicator of calcium-related disorders.
❓ Why is the Test Done?
To:
- Evaluate symptoms of calcium imbalance (e.g., muscle cramps, tingling, fatigue)
- Diagnose hypocalcemia or hypercalcemia
- Monitor critically ill patients, where pH and albumin levels affect total calcium
- Assess calcium status in chronic kidney disease, parathyroid disorders, vitamin D abnormalities
- Guide treatment for calcium supplementation or chelation therapy
📊 Normal Range
Age/Population | Ionised Calcium Reference Range |
|---|---|
Adults | 1.12 – 1.32 mmol/L (or 4.5 – 5.3 mg/dL) |
Children/Teens | Slightly higher than adult range |
Lab-specific variations exist. Values should be interpreted in clinical context.
📈 Interpretation of Results
Ionised Calcium Level | Possible Interpretation |
|---|---|
< 1.12 mmol/L (<4.5 mg/dL) | Hypocalcemia → Hypoparathyroidism, vitamin D deficiency, kidney failure, sepsis |
1.12 – 1.32 mmol/L | Normal (homeostasis maintained) |
> 1.32 mmol/L (>5.3 mg/dL) | Hypercalcemia → Hyperparathyroidism, malignancy, excess vitamin D, sarcoidosis |
Note: Ionised calcium is more accurate than total calcium, especially in cases of abnormal albumin or blood pH.
🧠 Associated Organs & Conditions
Organ/System | Associated Conditions |
|---|---|
Parathyroid | Hyperparathyroidism, hypoparathyroidism |
Kidneys | CKD, secondary hyperparathyroidism |
Bone | Osteoporosis, malignancies with bone metastasis |
Endocrine | Vitamin D deficiency, sarcoidosis, adrenal insufficiency |
Pancreas | Acute pancreatitis (can lower ionised calcium) |
🔄 Related / Follow-Up Tests
- Total Calcium
- Serum Albumin (for corrected calcium calculation)
- Parathyroid Hormone (PTH)
- Vitamin D (25-OH and 1,25-OH)
- Phosphate
- Magnesium
- Renal Function Tests (Urea, Creatinine)
- Arterial Blood Gas (ABG) – for pH affecting calcium
✅ Fasting Required?
Test | Fasting Requirement |
|---|---|
Ionised Calcium | ✅ Yes, 8–12 hours preferred to reduce post-meal pH fluctuations |
📝 Summary Table
Parameter | Details |
|---|---|
What | Measures biologically active calcium in blood |
Why | Assess calcium disorders in critical illness, kidney disease, endocrine dysfunction |
Normal Range | 1.12–1.32 mmol/L (4.5–5.3 mg/dL) |
High Value | Hyperparathyroidism, malignancy, excess vitamin D |
Low Value | Hypoparathyroidism, vitamin D deficiency, sepsis |
Follow-up Tests | Total calcium, PTH, Vit D, Mg, Phosphate, ABG |
Associated Conditions | Bone disorders, kidney disease, endocrine issues |
Fasting Required | ✅ Yes |
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