ABSTRACT
ABSTRACT Introduction: Serum osmolality is an essential laboratory parameter to understand several clinical disorders such as electrolyte disturbances, exogenous intoxication and hydration status. Objective: This study aims to update knowledge about the osmolality examination through research papers published to date. Materials and methods: The survey was conducted on PubMed database. It highlights main concepts, both historical and physiological aspects, and the clinical applications of the serum osmolality test. In addition, an extensive survey of formulas for the serum osmolality calculation was conducted. Discussion: The measurement of serum osmolality is relevant in changes in intracellular and extracellular balance, as a trusted and valuable indicator of solute concentration in the blood. The mathematical equations for serum osmolality calculation acquire relevance in health services where serum is not available, and situations in which calculation of the osmolal gap is necessary, but the variability of the formulas is a significant bias. Conclusion: The measurement of serum osmolality is useful in cases of dehydration, sodium and potassium disorders, glucose alteration, exogenous poisoning, adrenal insufficiency, neurological injury, physical exercise and others.
RESUMO Introdução: A osmolalidade sérica constitui um parâmetro laboratorial importante para compreensão de diversas desordens clínicas, como os distúrbios eletrolíticos, as intoxicações exógenas e o status de hidratação. Objetivo: Este trabalho visa atualizar os conhecimentos acerca do exame de osmolalidade por meio da pesquisa de artigos científicos publicados até a presente data. Materiais e métodos: A pesquisa foi realizada no banco de dados do PubMed. Este artigo de atualização aborda os principais conceitos, aspectos históricos, aspectos fisiológicos e aplicações clínicas do exame de osmolalidade sérica. Foi também realizado um levantamento das diferentes fórmulas propostas para o cálculo da osmolalidade sérica. Discussão: A medida da osmolalidade sérica é pertinente nas alterações do equilíbrio intra e extracelular, sendo um bom indicador para avaliar as concentrações de solutos no sangue. As fórmulas matemáticas para o cálculo da osmolalidade sérica são úteis quando a medida laboratorial não está disponível, bem como nas situações em que o cálculo do gap osmolal se faz necessário, mas a variabilidade das fórmulas é um viés significativo. Conclusão: A medida da osmolalidade sérica é útil na avaliação de diversas condições clínicas, como na desidratação, nos distúrbios dos íons sódio e potássio, nas disglicemias, nas intoxicações exógenas, na insuficiência adrenal, nas lesões neurológicas, nos exercícios físicos, entre outras.
ABSTRACT
This study was designed to determine serum osmolality and to investigate the association among serum osmolality, health-related factors and biochemical indices. Two hundred thirty seven elderly(86 male, 151 female : mean age 73.8) residing in the chungbuk area participated. Sociodemographic data and self-perceived health status were obtained by interview, and biochemical parameters were measured. The mean serum osmolaity was 301.2+/-10.1 mOsm/ kg(range 240.8~328.9 mOsm/ kg) and serum osmolality of the females(302.4 mOsm/ kg) was significantly(p<0.05) higher than that of the males(299.0 mOsm/ kg). Only 11.0% of the elderly were within the accepted normal range(280~295 mOsm/ kg) and the majority of the subjects were in a hyperosmolar state(60.8% : 296~307 mOsm/ kg). It was observed that serum osmolality was reduced with increasing age but not statistically significant. There was no significant difference in serum osmolality according to marital status. Serum osmolality was significantly lower(p<0.05) in the elderly with higher self-perceived health scores than the elderly with lower self-perceived health scores, however no significant difference was observed between the presence or absence of disease. Serum osmolality tended to be higher(p=0.06) in the elderly with difficulty in mobility than the elderly who have no problem in mobility. Serum osmolality tended to be higher(p=0.06) among drug users compared to that of non-users. There was a significant association between serum osmolality and serum albumin in females but not in males. Significant associations were shown between serum osmolality and serum transferrin in both sexes. However, there was no significant correlation between serum osmolality and hemoglobin or hematocrit except with hematocrit in females only. The results of this study indicated that the elderly were dehydrated and hydration state seems to influence health status and, the elderly should be encouraged to drink an adequate amount of fluids. Also, the hydration state is required to be assessed and considered for the interpretation of biochemical parameters.
Subject(s)
Aged , Female , Humans , Male , Dehydration , Drug Users , Hematocrit , Marital Status , Osmolar Concentration , Serum Albumin , TransferrinABSTRACT
The purpose of this study was to prevent the dilutional effect of excessive absorption of irrigating solution by using furosemide intraoperatively during transurethral resection of the prostate. Thirty patients, classified as ASA ps 2 or 3, were selected randomly and divided them into two groups as follows: Group l(N=15); Not-administrated furosemide(control group) Group 2(N=15); Administrated furosemide(Experimental group) All patients were premedicated with hydroxyzine(1 mg/kg, IM) and were performed continuous epidural anesthesia with 2/ lidocaine(1-1.5 mg/segment). 5% D-sorbitols were used for irrigating solution, and Hartmans solutions were given for maintenance fluid. And fixed the irrigating container to 60 cm in height from symphysis pubis. With the starting of operation, 20 mg furosemide was administrated to experimental group. The blood samples for serum Na+, K+, glucose and BUN were obtained at preoperation, 10 min, 20 min, 30 min after the stating of operation and immediate postoperative period, and serum osmolality and effective osmolality were calculated. The results were as follows: l) The values of sodium concentration of control group were decreased significantly at 10 min, 20 min, 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimental group were not changed significantly. 2) The values of serum osmolality and effective osmolality were decreased significantly at 30 min after the starting of operation and immediate postoperative period as compared with the preoperative value(p<0.05). But those of experimenta1 group were not changed significantly. These results show that the dilutional effect of excessive absorption of irrigating solution might be prevented by using furosemide intraopertively. So we would like to recommend the use of furosemide during TURP, especially in patients with congestive heart failure or renal failure.