Of concern, albumin-adjusted calcium only correlated modestly with ionized calcium and generally fared no better than (unadjusted) total calcium alone, but rather had the tendency to systematically underestimate true hypocalcemia, particularly in the presence of low serum albumin (ie, a scenario where adjustment formulas are likely to be relied on the most but paradoxically where they are least reliable). This evidence concerns the gene ALB and Hypocalcemia.