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What Causes Extremely High Ionized Calcium?
Question: My Mom (89 yrs old has extremely high ionized calcium (1.39), normal total calcium(1.32) & extremely high PTH, intact (153. She is in decent health with only 5mg fosinopril & 25mg matropolol for Rx. She has stage 3 chronic kidney disease. Doc says it's impossible to have high ionized yet normal total, so must be bad lab report. (done 2x with same result from 2 diff labs). See you in 6 months!
In addition, her dementia has suddenly taken a turn for the worse...much more confused in last few weeks.
Help me understand this & why to just disregard lab results with no special follow-ups.
In addition, her dementia has suddenly taken a turn for the worse...much more confused in last few weeks.
Help me understand this & why to just disregard lab results with no special follow-ups.
Brief Answer:
Calcium
Detailed Answer:
Sorry to hear about your mother's dementia.
Ionized calcium is actually a more reliable test than total calcium. Total calcium can be falsely low or normal depending on the serum albumin levels. There are other things that affect the blood calcium levels too in terms of giving falsely high or low values. So the best test to determine if someone has a calcium abnormality in the blood is to perform the ionized calcium test.
In this instance, the ionized appears to be high, although I would like to see the ranges on the lab report for both the results you have shared.
I would also like to know her serum creatinine and albumin levels. I have noted her high PTH. Her high calcium levels merit further testing such as serum phosphorus and 25 hydroxy vitamin D levels. The medical diagnosis here is 'Hypercalcemia' and 'Hyperparathyroidism'.
She will benefit from a systematic evaluation by an endocrinologist to distinguish between 'Primary or Tertiary hyperparathyroidism'
Calcium
Detailed Answer:
Sorry to hear about your mother's dementia.
Ionized calcium is actually a more reliable test than total calcium. Total calcium can be falsely low or normal depending on the serum albumin levels. There are other things that affect the blood calcium levels too in terms of giving falsely high or low values. So the best test to determine if someone has a calcium abnormality in the blood is to perform the ionized calcium test.
In this instance, the ionized appears to be high, although I would like to see the ranges on the lab report for both the results you have shared.
I would also like to know her serum creatinine and albumin levels. I have noted her high PTH. Her high calcium levels merit further testing such as serum phosphorus and 25 hydroxy vitamin D levels. The medical diagnosis here is 'Hypercalcemia' and 'Hyperparathyroidism'.
She will benefit from a systematic evaluation by an endocrinologist to distinguish between 'Primary or Tertiary hyperparathyroidism'
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Her doctor said she had never seen a high ionized calcium with a normal total & therefore believed the lab results were wrong...she is a geriatric specialist...lots of experience including med school here. She had even checked with her dept head about the conflicting results. Oh...the endocrinologists in her group are one floor up from her office...but she did not check with them.
Do not have Serum Phosphorus or 25 Hydroxy Vitamin D levels (but she had been taking a XXXXXXX Vitamin pill...per her Dr... for Vitamin D since Mom is indoors a lot...(senior multiple vitamin, not just a vitamin D pill...I thought odd since prior problem with high potassium levels)
Ionized calcium range 1.09-1.31...lab report flagged Mom's 1.39 as critically high
PTH, Intact results was 153
Range
Primary Hyperparathyroidism Calcium 10.1-15.2mg/dl PTH Higher than 72mg/dl
Secondary Hyperparathyroidism Calcium 4.0-8.5mg/dl PTH Higher than 72mg/dl
Creatinine 1.4 (range 0.6-1.1) flagged as High
BUN 33 (range 7-18) Flagged as High
Chloride Serum 112 (range 96-108) flagged as High
Albumin 3.4 (range 2.9-4.9) Normal
Potassium 5.3 (range 3.3-5.1) flagged as high
Her GFR (non-Afric Amer)38
Chronic Kidney disease: less than 61ml/min/1.73 sq meters
End Stage Renal Disease: Less than 15ml/min/1.73 sq meter
Alkaline Phosphatase 69 (range 50-120)
everything else was within Normal Range
Do not have Serum Phosphorus or 25 Hydroxy Vitamin D levels (but she had been taking a XXXXXXX Vitamin pill...per her Dr... for Vitamin D since Mom is indoors a lot...(senior multiple vitamin, not just a vitamin D pill...I thought odd since prior problem with high potassium levels)
Ionized calcium range 1.09-1.31...lab report flagged Mom's 1.39 as critically high
PTH, Intact results was 153
Range
Primary Hyperparathyroidism Calcium 10.1-15.2mg/dl PTH Higher than 72mg/dl
Secondary Hyperparathyroidism Calcium 4.0-8.5mg/dl PTH Higher than 72mg/dl
Creatinine 1.4 (range 0.6-1.1) flagged as High
BUN 33 (range 7-18) Flagged as High
Chloride Serum 112 (range 96-108) flagged as High
Albumin 3.4 (range 2.9-4.9) Normal
Potassium 5.3 (range 3.3-5.1) flagged as high
Her GFR (non-Afric Amer)38
Chronic Kidney disease: less than 61ml/min/1.73 sq meters
End Stage Renal Disease: Less than 15ml/min/1.73 sq meter
Alkaline Phosphatase 69 (range 50-120)
everything else was within Normal Range
Brief Answer:
Follow up
Detailed Answer:
I strongly recommend you get an Endocrinologists' opinion. This is a complex calcium-parathyroid matter that deserves full evaluation by none other than an Endocrinologist
Follow up
Detailed Answer:
I strongly recommend you get an Endocrinologists' opinion. This is a complex calcium-parathyroid matter that deserves full evaluation by none other than an Endocrinologist
Note: For more information on hormonal imbalance symptoms or unmanaged diabetes with other comorbid conditions, get back to us & Consult with an Endocrinologist. Click here to book an appointment.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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