Direct Ion-selective Electrode Method is Useful in Diagnosis of Pseudohyponatremia

Dhatt, Gurjit S.; Talor, Zvi; Kazory, Amir

doi:10.1016/j.jemermed.2011.07.021

Cited by 17 publications

(8 citation statements)

References 2 publications

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“…Other methods for diagnosing pseudohyponatraemia include direct potentiometry using a blood gas analyser (i.e. direct ion-specific electrode measurement) in which case no dilution of the sample occurs, or measurement of serum triglycerides, cholesterol and total protein concentration (30,97,98). Differences between direct and indirect ion-specific electrode measurement of 5-10% have been reported in hypotonic hyponatraemia (99,100).…”

Section: Pseudohyponatraemiamentioning

confidence: 99%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

633

671

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Hyponatraemia, defined as a serum sodium concentration !135 mmol/l, is the most common disorder of body fluid and electrolyte balance encountered in clinical practice. It can lead to a wide spectrum of clinical symptoms, from subtle to severe or even life threatening, and is associated with increased mortality, morbidity and length of hospital stay in patients presenting with a range of conditions. Despite this, the management of patients remains problematic. The prevalence of hyponatraemia in widely different conditions and the fact that hyponatraemia is managed by clinicians with a broad variety of backgrounds have fostered diverse institution-and speciality-based approaches to diagnosis and treatment. To obtain a common and holistic view, the European Society of Intensive Care Medicine (ESICM), the European Society of Endocrinology (ESE) and the European Renal Association -European Dialysis and Transplant Association (ERA-EDTA), represented by European Renal Best Practice (ERBP), have developed the Clinical Practice Guideline on the diagnostic approach and treatment of hyponatraemia as a joint venture of three societies representing specialists with a natural interest in hyponatraemia. In addition to a rigorous approach to methodology and evaluation, we were keen to ensure that the document focused on patient-important outcomes and included utility for clinicians involved in everyday practice.

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Section: Pseudohyponatraemiamentioning

confidence: 99%

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Spasovski

Vanholder

Allolio

et al. 2014

European Journal of Endocrinology

633

671

View full text Add to dashboard Cite

show abstract

“…If a hyperlipidemic or hyperproteinemic patient presents with hyponatremia, one should consider the diagnosis of spurious hyponatremia . The chemistry laboratory that measured the low plasma sodium level should be consulted to find out which method was used to measure the sodium level.…”

Section: Discussionmentioning

confidence: 99%

“…In this new situation, the calculated plasma osmolarity will be (2 9 102) + 10/2.8 + 100/ 18 = 213 mmol/l and the osmol gap will be 287À213 = 74 mmol/l, a value much higher than the normal value of about 10 mmol/l. If a hyperlipidemic or hyperproteinemic patient presents with hyponatremia, one should consider the diagnosis of spurious hyponatremia (102,103). The chemistry laboratory that measured the low plasma sodium level should be consulted to find out which method was used to measure the sodium level.…”

Section: Dysnatremiasmentioning

confidence: 99%

Osmotic Pressure in Clinical Medicine with an Emphasis on Dialysis

Raimann

Tzamaloukas

Levin

et al. 2016

Seminars in Dialysis

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Since the beginning of life of the first multicellular organisms, the preservation of a physiologic milieu for every cell in the organism has been a critical requirement. A particular range of osmolality of the body fluids is essential for the maintenance of cell volume. In humans the stability of electrolyte concentrations and their resulting osmolality in the body fluids is the consequence of complex interactions between cell membrane functions, hormonal control, thirst, and controlled kidney excretion of fluid and solutes. Knowledge of these mechanisms, of the biochemical principles of osmolality, and of the relevant situations occurring in disease is of importance to every physician. This comprehensive review summarizes the major facts on osmolality, its relation to electrolytes and other solutes, and its relevance in physiology and in disease states with a focus on dialysis-related considerations.

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“…In pseudohyponatremia, the water component is diluted by non-aqueous materials such as lipids and proteins. In conditions like hyperlipidemia and hyperproteinemia, abnormally high levels of these large molecules replace the aqueous phase of plasma, thus resulting in a reduced amount of serum electrolytes per unit volume of serum [ 6 , 7 ]. When measured with conventional flame photometry or indirect potentiometry, which involves prior dilution of the samples, the measured sodium concentration is low but the true plasma concentration is normal [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

“…Hyponatremia is defined as the plasma sodium level less than 135 mmol/L and its prevalence in a hospital setting is up to 12% [1][2][3]. Pseudohyponatremia refers to low serum sodium in the presence of normal plasma tonicity [4][5][6]. In pseudohyponatremia, the water component is diluted by non-aqueous materials such as lipids and proteins.…”

Section: Introductionmentioning

confidence: 99%

Pseudohyponatremia Leading to a Fatal Outcome in a Patient With Familial Hypertriglyceridemia

Dawson¹,

Kanukuntla²,

Kata³

et al. 2021

Cureus

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Serum sodium assay is a commonly performed laboratory test in a clinical setting and the results are taken for granted without being aware of the actual methods involved. In conditions like hyperlipidemia and hyperproteinemia, excessive lipids in serum dilute the water component of the serum. Since sodium is dissolved only in the aqueous phase of serum, the sodium content per unit volume of plasma is reduced. Currently, most of the laboratories use the indirect ion-selective electrode method (ISE), where the plasma sample is diluted before the measurement. Indirect ISE may not give accurate results in conditions with higher serum lipid and protein levels. Overcorrection of the serum sodium levels in pseudohyponatremia may cause serious complications. We report a case of a 26-year-old Asian male with a past medical history of chronic pancreatitis, familial hypertriglyceridemia, and fatty liver who presented to the emergency department with acute pancreatitis. Initially, the patient was found to have hyponatremia and he was started on hypertonic saline for one day. Later the patient’s condition deteriorated and then it was determined that serum sodium results were a measurement artifact since the patient had extremely high levels of triglycerides. After realizing that it was a measurement artifact, the saline infusion was stopped and he was started on desmopressin. However, the patient deteriorated neurologically and expired later. As this patient had normal sodium levels, administration of hypertonic saline led to a fatal outcome.

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Direct Ion-selective Electrode Method is Useful in Diagnosis of Pseudohyponatremia

Cited by 17 publications

References 2 publications

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Clinical practice guideline on diagnosis and treatment of hyponatraemia

Osmotic Pressure in Clinical Medicine with an Emphasis on Dialysis

Pseudohyponatremia Leading to a Fatal Outcome in a Patient With Familial Hypertriglyceridemia

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