The challenges of sodium measurements: indirect versus direct ion-selective method

Refardt, Julie; Sailer, Clara O; Chifu, Irina; Winzeler, Bettina; Schnyder, Ingeborg; Fassnacht, Martin; Fenske, Wiebke

doi:10.1530/eje-19-0101

Cited by 15 publications

(6 citation statements)

References 20 publications

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“…These findings were consistent with previous studies. [12][13][14] According to Clinical Laboratory Improvement Amendments (CLIA), the total allowable error for performing serum sodium is ± 4 mmol/l. 15 Our study concluded that there was an increase in the difference between indirect versus direct ISE-measured serum sodium as the level of albumin decreased in the sample.…”

Section: Discussionmentioning

confidence: 99%

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Paracha

Haroon²,

Aamir³

et al. 2023

PAFMJ

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Objective: To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method. Study Design: Cross-sectional study Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021. Methodology: Patients of either gender, aged 18 to 70 years, who were admitted to the Intensive Care Unit of Combined Military Hospital, Rawalpindi, were selected. A total of 200 blood samples were collected in a gel tube. Serum samples were analyzed for albumin and sodium within two hours of sample collection. Sodium levels were measured concurrently by both direct and indirect ISE methods. The difference in results between these two techniques was studied. Results: Hypoalbuminemia was detected in 176(88%) patients, while 24(12%) had normal albumin levels. In Hypoalbuminemic patients, serum sodium measurements were higher using the indirect ISE method(134.07±5.55) compared to the direct ISE method (130.95±6.04); the difference between the two techniques was statistically significant (p-value <0.001).Pearson correlation coefficient (r-value = -0.86, p-value <0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased. Conclusion: In Hypoalbuminemic patients, the indirect ISE method gave falsely raised results of serum sodium. In such patients, serum sodium measurement by the Direct ISE method offers more accurate and consistent electrolyte results.

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Section: Discussionmentioning

confidence: 99%

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Paracha

Haroon²,

Aamir³

et al. 2023

PAFMJ

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“…In our platforms, VBG sodium concentration was on average 1.9 mmol/L lower than simultaneously-obtained serum sodium. One study from two European Hospitals compared sodium measurements ascertained via indirect (plasma/serum) vs direct (whole blood/VBG) methods in 231 participants undergoing HTS infusion ( 23 ). In agreement with our findings, sodium measured on blood gas platforms, was, on average, 1.9 mmol/L lower than serum/plasma.…”

Section: Discussionmentioning

confidence: 99%

“…One approach when using HTS would be to factor in this approximate 2 mmol/L difference between blood gas vs serum/plasma sodium concentrations. However, while this difference is within an acceptable range in absolute numerical terms, it is clinically significant in the context of HTS use ( 23 ). It is thus critical to use a consistent approach in obtaining sodium concentrations when using HTS as opposed to switching between serum/plasma and blood gas sodium.…”

Section: Discussionmentioning

confidence: 99%

“…It is thus critical to use a consistent approach in obtaining sodium concentrations when using HTS as opposed to switching between serum/plasma and blood gas sodium. A logical approach would be to only use a quick turnaround test like VBG sodium to avoid under or over-estimation, due to differences in modalities used to quantify sodium ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

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Hypertonic saline for severe symptomatic hyponatraemia: real-world findings from the UK

Arshad

Iqbal

Weeks

et al. 2022

Endocrine Connections

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Objective: To evaluate ‘real-world’ safety and efficacy of the European Society of Endocrinology (ESE) guidelines for treatment of severe symptomatic hyponatraemia using hypertonic saline (HTS). Design: Retrospective, observational, cohort study, examining the use of HTS for severe symptomatic hyponatraemia at Sheffield Teaching Hospitals between 2017-2020. Methods: Patients were identified from pharmacy records and demographic, clinical, and treatment data extracted. Results: Out of 112 patients (Females: Males=61:51), the mean age ± SD was 66.3± 16.0 years and mean pre-treatment serum sodium ± SD was 113.8 ± 6.4 mmol/L. Overall, overcorrection rates at 24 and 48 hours (>10mmol/L and >18mmol/L) were 44.9% and 19.6%, respectively while 19.6% of patients were treated for overcorrection. Above-target rise in sodium (>5mmol/L) after first and second boluses was noted in 22.6% and 34.6% of patients. In-hospital and 12-month mortality was 7.1% and 18.7% respectively with no cases of osmotic demyelination (ODS). The mean venous blood gas (VBG) sodium was 1.9 mmol/L lower than paired serum sodium (n=32)(113.6 ± 6.6 vs. 115.7 ± 7.8 mmol/L). Conclusion: We report real-world data demonstrating that a significant number of patients overcorrected using current guidelines. Also, several patients had above-target rise in sodium after one bolus of HTS, and sodium measurement should be considered before the second bolus unless ongoing severe symptoms persist. A point of care VBG sodium concentration was useful for this purpose. In addition to careful monitoring, a cautious but anticipatory overcorrection prevention strategy should be considered in the first 24 hours.

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“…All these methods report data from wet tissue or dry tissue measurement with varying levels of repeatability and reproducibility. However, all these methods require a significantly large tissue sample, of either approximately 0.5 cm in diameter or a tumor tissue volume of around 50–70 μL [ 79 , 80 , 81 , 82 , 83 ]. Further, these techniques cannot differentiate between extracellular versus intracellular sodium concentrations.…”

Section: Application Of Sodium Mri As a Prognostic And/or Diagnostic Markermentioning

confidence: 99%

Cancer Salt Nostalgia

Allu

Tiriveedhi

2021

Cells

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High-salt (sodium chloride) diets have been strongly associated with disease states and poor health outcomes. Traditionally, the impact of salt intake is primarily studied in cardiovascular diseases, hypertension and renal diseases; however, recently there has been increasing evidence demonstrating the role of salt in autoimmune diseases. Salt has been shown to modulate the inflammatory activation of immune cells leading to chronic inflammation-related ailments. To date, there is minimal evidence showing a direct correlation of salt with cancer incidence and/or cancer-related adverse clinical outcomes. In this review article, we will discuss the recent understanding of the molecular role of salt, and elucidate the apparent double-edged sword nature of the relationship between salt and cancer progression.

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The challenges of sodium measurements: indirect versus direct ion-selective method

Cited by 15 publications

References 20 publications

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method

Hypertonic saline for severe symptomatic hyponatraemia: real-world findings from the UK

Cancer Salt Nostalgia

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