Nephrol Dial Transplant (2003) 18: 1266-1271
© 2003 European Renal Association-European Dialysis and Transplant Association
Hypothesis
Are the total exchangeable sodium, total exchangeable potassium and total body water the only determinants of the plasma water sodium concentration?
Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, USA
Keywords: plasma water sodium concentration; total body water; total exchangeable potassium; total exchangeable sodium
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Introduction
The dysnatraemias are common electrolyte disorders encountered in hospitalized patients [1]. The pathophysiology and approach to management of these electrolyte disorders have been well characterized. It is well known that the total exchangeable sodium (Nae), total exchangeable potassium (Ke) and total body water (TBW) are the major determinants of the plasma water sodium concentration ([Na+]pw) [2]. Changes in the mass balance of Na+, K+ and water, therefore, determine the quantitative impact on the [Na+]pw. Several formulas (sodium deficit equation, water deficit equation, Androgue–Madias equation and Barsoum–Levine equation) have been derived to help predict the changes in plasma Na+ concentration ([Na+]p) following a therapeutic manoeuvre [3–8]. However, although Edelman et al. [2] demonstrated that the plasma water sodium concentration is equal to 1.11(Nae+Ke)/TBW-25.6, the significance of the y-intercept
Results
Determination of the physiologic importance of the y-intercept in Edelman's equation
Discussion
(Naosm inactive+Kosm inactive)/TBW
(OsmolECF+osmolICF)/TBW
[K+]pw
Osmolpw/Vpw
Change in the y-intercept in hyperglycaemia-induced hyponatraemia
Clinical application: practical examples
Importance of the y-intercept in hyperglycaemia-induced hyponatraemia
Role of osmotically inactive Nae and Ke in the determination of the [Na+]pw
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