A 68-year-old man with cirrhosis has serum calcium of 8.0 mg/dL and serum albumin of 2.0 g/dL. He is asymptomatic with no Chvostek or Trousseau sign. What is his corrected serum calcium?

• A 8.0 mg/dL
• B 8.8 mg/dL
• C 9.6 mg/dL ✓
• D 10.4 mg/dL

Explanation

Corrected calcium = measured calcium + 0.8 x (4 - albumin in g/dL) = 8.0 + 0.8 x (4 - 2) = 9.6 mg/dL, which is normal, explaining the absence of tetany. Roughly half of circulating calcium is bound to albumin, so hypoalbuminemia lowers total calcium without changing ionized calcium. Option A ignores the correction entirely, and option B applies only half the required adjustment.

Reference: Harrison's Principles of Internal Medicine, 21st ed.

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