Severe hyponatraemia in hyperlipaemic diabetic ketosis.

Bell, James A.; Hilton, P. J.; Walker, G.

doi:10.1136/bmj.4.5842.709

Cited by 16 publications

(3 citation statements)

References 4 publications

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“…18.22 Firstly, spectrophotometric measurements are inaccurate when gross turbidity is encountered and serum blanking as a first effort cannot always obviate or alleviate this troublesome aspect of the determinations; secondly, lipids, especially the triglycerides, are molecules that can elevate to very high concentrations and thus create a n analytical circumstance in which short sampling diminishes the values of analytes; thirdly, a physiological problem can be caused if there is an increased volume of plasma that may dilute the hemoglobin concentration of whole blood; fourthly, there can be a viscosity affect that, like the volume effect, may result in short sampling when certain peristaltic pumps are a part of an instrument such as a flame photometer; and fifthly, reference bases for serum can be different owing to volume changes for the two components of an important risk factor such as the percentage of high density lipoprotein cholesterol ratioed to that of total cholesterol. In addition, considerations should be given to the inclusion of fatty acid esters of the major portion of total cholesterol in reported values because they are an integral part of the molecule that is coursing through our veins.…”

Section: Discussionmentioning

confidence: 97%

Problems with Measurements Caused by High Concentrations of Serum Solids

Artiss

Zak

1987

CRC Critical Reviews in Clinical Laboratory Sciences

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There have been numerous reports of spectrophotometric and volume problems caused by elevated levels of lipids in blood. The offending lipids, primarily triglycerides, not only cause turbidity leading to optical aberrations when added to analytical reagents, but also result in short-sampling errors leading to the measurement of inaccurate volumes of sample. Numerous methods have been developed to clear the lipemia, including ultracentrifugation organic solvent extraction, chemical precipitation and, most recently, enzymic hydrolysis. Although the latter procedures eliminate the optical problems, they do not deal with the volume dilution error created by the triglycerides. In turn, corrective mathematics have been developed to compensate for the inaccurate pipetting caused by the elevated lipids in a sample; however, these empirical calculations are not truly accurate at high concentrations of total lipids. This monograph will describe the problems caused by the presence of elevated lipids and the means available for treating them.

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Section: Discussionmentioning

confidence: 97%

Problems with Measurements Caused by High Concentrations of Serum Solids

Artiss

Zak

1987

CRC Critical Reviews in Clinical Laboratory Sciences

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“…Table 3 lists clinical states in which pseudohyponatremia has been reported, including conditions associated with hyperproteinemia [41,[66][67][68][69][70][71][72][73][74][75][76][77][78][79][80], hypertriglyceridemia [19,68,[81][82][83][84][85][86][87][88][89][90][91][92][93][94][95][96][97] and hypercholesterolemia [98][99][100][101][102][103][104][105][106][107][108][109][110][111][112]…”

Section: Clinical Conditions Associated With Pseudohyponatremiamentioning

confidence: 99%

“…Table 3 lists clinical states in which pseudohyponatremia has been reported, including conditions associated with hyperproteinemia [ 41 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 ], hypertriglyceridemia [ 19 , 68 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 , 94 , 95 , 96 , 97 ] and hypercholesterolemia [ 98 , 99 , 100 , 101 , 102 , 103 , 104 , 105 , 106 , 107 , 108 , 109 , 110 , 111 , 112 , 113 , 114 ].…”

Section: Clinical Conditions Associated With Pseudohyponatremiamentioning

confidence: 99%

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

Aziz

Sam

Lew

et al. 2023

JCM

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Pseudohyponatremia remains a problem for clinical laboratories. In this study, we analyzed the mechanisms, diagnosis, clinical consequences, and conditions associated with pseudohyponatremia, and future developments for its elimination. The two methods involved assess the serum sodium concentration ([Na]S) using sodium ion-specific electrodes: (a) a direct ion-specific electrode (ISE), and (b) an indirect ISE. A direct ISE does not require dilution of a sample prior to its measurement, whereas an indirect ISE needs pre-measurement sample dilution. [Na]S measurements using an indirect ISE are influenced by abnormal concentrations of serum proteins or lipids. Pseudohyponatremia occurs when the [Na]S is measured with an indirect ISE and the serum solid content concentrations are elevated, resulting in reciprocal depressions in serum water and [Na]S values. Pseudonormonatremia or pseudohypernatremia are encountered in hypoproteinemic patients who have a decreased plasma solids content. Three mechanisms are responsible for pseudohyponatremia: (a) a reduction in the [Na]S due to lower serum water and sodium concentrations, the electrolyte exclusion effect; (b) an increase in the measured sample’s water concentration post-dilution to a greater extent when compared to normal serum, lowering the [Na] in this sample; (c) when serum hyperviscosity reduces serum delivery to the device that apportions serum and diluent. Patients with pseudohyponatremia and a normal [Na]S do not develop water movement across cell membranes and clinical manifestations of hypotonic hyponatremia. Pseudohyponatremia does not require treatment to address the [Na]S, making any inadvertent correction treatment potentially detrimental.

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Die Wasservergiftung

Truniger¹

1974

Achtzigster Kongress

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Severe hyponatraemia in hyperlipaemic diabetic ketosis.

Cited by 16 publications

References 4 publications

Problems with Measurements Caused by High Concentrations of Serum Solids

Problems with Measurements Caused by High Concentrations of Serum Solids

Pseudohyponatremia: Mechanism, Diagnosis, Clinical Associations and Management

Die Wasservergiftung

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