In blood, approximately 50% of the plasma calcium is free, 40 to 45% is protein bound mainly associated with albumin and between 5 to 10% is complexed. Calcemia measures total calcium but only free calcium is biologically active. Calcium plays an active physiological role in bone mineralization, neuromuscular excitability, muscle contraction, and blood coagulation. Serum protein levels must be considered for the proper interpretation of total serum calcium levels. Hypocalciumia can result from chronic renal failure with hypercreatinemia and hypophosphatemia, o r hypoparathyroidim, or vitamin D deficiency.