What condition might be indicated by a normal calcium level in the presence of low albumin?

A normal calcium level in the presence of low albumin suggests that the calcium being measured is in a physiological context that accounts for the albumin levels. Albumin binds to a significant portion of serum calcium (approximately 40% of total calcium is bound to albumin). Therefore, when albumin levels are low, one might expect total serum calcium to be low as well if the calcium is not adjusted for albumin levels.

However, if the total serum calcium is normal despite low albumin, this can indicate that the levels of ionized calcium (the biologically active form) are still adequate, or that there is excess calcium in the body, reflecting hypercalcemia. In this scenario, the total calcium level may appear normal while the albumin level is low, which can mask an underlying hypercalcemic state.

Hypocalcemia would be indicated by low calcium levels in conjunction with low albumin because the binding of calcium to albumin would also lower the total serum calcium level when albumin is low. Hypomagnesemia and adrenal insufficiency do not directly correlate with albumin and calcium discrepancies as described in the question.

Given this information, the presence of a normal calcium level alongside low albumin is consistent with hypercalcemia, as the