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The authors comment

Walker and Payne' recently reported no significant interindividual differences between factors used to correct calcium for abnormal albumin concentrations in 15 patients with myocardial infarction. These data have further confused the corrected calcium conflict. Our data on interindividual variation in correction factors is based on 25 patients with a wide variety of diseases2 3 as well as on 17 healthy subjects undergoing a tourniquet test.4 Both groups showed clinically and statistically significant (p < 0-001 and < 0-05, respectively) interindividual differences. Because we have noted a high prevalence of hypercalcaemia in patients with a myocardial infarction (11 of 100 consecutive cases) we wondered if the different results of Walker and Payne had occurred because they had studied a special patient group. We therefore reviewed 22 patients who presented with myocardial infarction at the same time as our original study. Calcium and albumin measurements had been performed by dye-binding methods on the Technicon SMA 12/60 with typical between-batch coefficients of variation of 1-8% and 2% respectively. The mean spontaneous change in albumin concentration was 5-8 ± 0.52 (SEM) g/l. Interestingly, there was no significant interindividual variation in correction factors in these patients (p > 0.35).5 We believe that myocardial infarction may affect calcium metabolism, and this deserves further study. However, in patients with other diseases, calcium correction factors vary. The conflict continues!