MO188RECONSIDERING THE EDELMAN EQUATION: IMPACT OF INDIVIDUAL TOTAL BODY CATION CONTENT AND BODY WEIGHT
Abstract Background and Aims Treatment of dysnatremias is guided by formulas that are based on the Edelman equation, including Adrogue-Madias’ and others. Edelman’s equation is the result of a unique study in which serum sodium concentration ([Na+]), total body exchangeable sodium (Nae+) and potassium (Ke+) and total body water (TBW) were measured in a highly heterogeneous population. Because these observations resulted from steady state observations, the equation might not account for the recently uncovered highly dynamic Na+ body compartment where Na+ is temporarily stored and released without affecting TBW. Various factors that influence this Na+ body compartment have been identified and we questioned as to what extent these factors affect associations between serum [Na+] and [Nae+Ke]/TBW. Method We performed a post-hoc analysis of original data published by Edelman. In the linear regression model, effects of sex, edema (y/n), age and body weight (>/< median split) were examined. Serum [Na+] was calculated by multiplying serum water [Na+] of the original data set by 0.93. Using piecewise regression, we analyzed differences in slope and y-intercept for the regression between serum [Na+] and increasing values of (Nae+Ke)/TBW, in which the clinical characteristics from the subgroups were included as interaction factors . Results Data was available for 85 measurements in 82 patients; 57 males and 25 females. The median age (range) age was 58 (27-90) years and median weight (range) was 59.6 (36.4 – 168.2) kilograms. Median serum [Na+] (range) was 131.4 (103.4 – 150.2) mmol/L. The association between serum [Na+] and (Nae+Ke)/TBW was different for high and low weight categories (figure 1A). Sex, age or presence of edema did not alter the relationship. Piecewise regression showed a significant decrease in slope in the regression between serum [Na+] and (Nae+Ke)/TBW above 149 mmol/L (Nae+Ke)/TBW (figure 1B). Conclusion Edelman equation’s coefficients are significantly affected by weight and total body cation content. In subjects with a low weight and low total body cation content, the Edelman equation seems to adequately predict the course of serum [Na+]. However, the clinical use of the Edelman-based formulas may be hampered in subjects with higher weight and higher total body cation content, which may reflect increased tissue Na+ storage. Our analysis underlines the importance of further research into the role of osmotically inactive Na+ storage in osmoregulation.