Interrelations Between Serum Sodium Concentration, Serum Osmolarity and Total Exchangeable Sodium, Total Exchangeable Potassium and Total Body Water1

Eighteen patients with hyperosmolar non-ketotic diabetic coma were studied retrospectively to identify factors affecting prognosis and to review treatment. This condition affected older women two-thirds of whom were unrecognised diabetics. Eight (44%) died. Mortality correlated with age above 60, uraemia and hyperosmolarity, but not with the degree or rate of fall of hyperglycaemia. Hyperglycaemia responded to rehydration and insulin, but in all patients serum osmolarity remained high for several days. In 14 patients (78%) the serum sodium concentration initially increased and in four (22 %) serum osmolarity increased. This persistence or worsening of the hyperosmolar state can be avoided without the risk of cerebal oedema by replacing the fluid and electrolyte deficits over 48 hours and using 5% dextrose for the water deficit.

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Are the total exchangeable sodium, total exchangeable potassium and total body water the only determinants of the plasma water sodium concentration?

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfg112 ◽

2003 ◽

Vol 18 (7) ◽

pp. 1266-1271 ◽

Cited By ~ 26

Author(s):

M. K. Nguyen ◽

I. Kurtz

Keyword(s):

Total Body Water ◽

Sodium Concentration ◽

Body Water ◽

Exchangeable Sodium ◽

Exchangeable Potassium ◽

Total Body

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Body Sodium, Potassium and Water in Peritoneal Dialysis-Associated Hyponatremia

Peritoneal Dialysis International ◽

10.3747/pdi.2012.00201 ◽

2014 ◽

Vol 34 (3) ◽

pp. 253-259 ◽

Cited By ~ 3

Author(s):

Yijuan Sun ◽

David Mills ◽

Todd S. Ing ◽

Joseph I. Shapiro ◽

Antonios H. Tzamaloukas

Keyword(s):

Peritoneal Dialysis ◽

Clinical Evaluation ◽

Serum Sodium ◽

Total Body Water ◽

Sodium Concentration ◽

Body Water ◽

Serum Sodium Concentration ◽

Monovalent Cations ◽

Body Sodium ◽

Total Body

Objective This report presents a method quantitatively analyzing abnormalities of body water and monovalent cations (sodium plus potassium) in patients on peritoneal dialysis (PD) with true hyponatremia. Methods It is well known that in the face of euglycemia serum sodium concentration is determined by the ratio between the sum of total body sodium plus total body potassium on the one hand and total body water on the other. We developed balance equations that enabled us to calculate excesses or deficits, relative to the state of eunatremia and dry weight, in terms of volumes of water and volumes of isotonic solutions of sodium plus potassium when patients presented with hyponatremia. We applied this method retrospectively to 5 episodes of PD-associated hyponatremia (serum sodium concentration 121–130 mEq/L) and compared the findings of the method with those of the clinical evaluation of these episodes. Results Estimates of the new method and findings of the clinical evaluation were in agreement in 4 of the 5 episodes, representing euvolemic hyponatremia (normal total body sodium plus potassium along with water excess) in 1 patient, hypovolemic hyponatremia (deficit of total body sodium plus potassium along with deficit of total body water) in 2 patients, and hypervolemic hyponatremia (excess of total body sodium along with larger excess of total body water) in 1 patient. In the 5th patient, in whom the new method suggested the presence of water excess and a relatively small deficit of monovalent cations, the clinical evaluation had failed to detect the cation deficit. Conclusions Evaluation of imbalances in body water and monovalent cations in PD-associated hyponatremia by the method presented in this report agrees with the clinical evaluation in most instances and could be used as a guide to the treatment of hyponatremia. Prospective studies are needed to test the potential clinical applications of this method.

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Edelman Revisited: Concepts, Achievements, and Challenges

Frontiers in Medicine ◽

10.3389/fmed.2021.808765 ◽

2022 ◽

Vol 8 ◽

Author(s):

Mark Rohrscheib ◽

Ramin Sam ◽

Dominic S. Raj ◽

Christos P. Argyropoulos ◽

Mark L. Unruh ◽

...

Keyword(s):

Serum Sodium ◽

Quantitative Methods ◽

Sodium Concentration ◽

Body Fluids ◽

Body Water ◽

Serum Sodium Concentration ◽

Sodium Potassium ◽

Body Sodium ◽

Total Body

The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.

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The Available Clinical Approaches to the Management of Patients with Acute and Chronic Hypernatremia

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.4270 ◽

2020 ◽

Vol 8 (F) ◽

pp. 1-10

Author(s):

Asaad Moradi ◽

Foroogh Sabzghabaei ◽

Mohammadshahab Kalantar

Keyword(s):

Cerebral Edema ◽

Serum Sodium ◽

Total Body Water ◽

Sodium Concentration ◽

Clinical Treatment ◽

The Other ◽

Present Review ◽

Serum Sodium Concentration ◽

A Value ◽

Total Body

Hypernatremia has been known as a conventional electrolyte problem and is defined as a serum sodium concentration growth up to a value above 145 mmol/l. This disease is also known as a hyperosmolar condition, which is resulted from a reduction in total body water compared to the electrolyte content. Since two types of hypernatremia, including acute and chronic, exist, in the present study, we will review the available clinical approaches for the management of patients with acute and chronic hypernatremia. To this end, 68 studies having the criteria of the present review and published from 2000 were chosen and their data were extracted. The inclusion criterion was to be mainly focused on hypernatremia clinical treatment and those having side topics were excluded from the study. Acute symptomatic hypernatremia is a disease that occurs in <24 h and needs to be treated immediately. On the other hand, there is a chronic hypernatremia that occurs in a duration of more than 48 h and is required to be treated at a lower speed due to cerebral edema risks during treatment. Finally, for providing beneficial outcomes to patients, both chronic and acute hypernatremia need to be compared thoroughly and also more investigation needs to be done.

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