title: How to Solve the Underestimated Problem of Overestimated Sodium Results in the Hypoproteinemic Patient.
abstract: OBJECTIVE
  The availability of a fast and reliable sodium result is a prerequisite for the appropriate correction of a patient's fluid balance. Blood gas analyzers and core laboratory chemistry analyzers measure electrolytes via different ion-selective electrode methodology, that is, direct and indirect ion-selective electrodes, respectively. Sodium concentrations obtained via both methods are not always concordant. A comparison of results between both methods was performed, and the impact of the total protein concentration on the sodium concentration was investigated. Furthermore, we sought to develop an adjustment equation to correct between both ion-selective electrode methods.
  
  
  METHODS
  A model was developed using a pilot study cohort (n = 290) and a retrospective patient cohort (n = 690), which was validated using a prospective patient cohort (4,006 samples).
  
  
  METHODS
  ICU and emergency department at Ghent University Hospital.
  
  
  METHODS
  Patient selection was based on the concurrent availability of routine blood gas Na⁺(direct) as well as core laboratory Na⁺(indirect) results.
  
  
  METHODS
  In the pilot study, left-over blood gas syringes were collected for further laboratory analysis.
  
  
  RESULTS
  There was a significant negative linear correlation between Na⁺(indirect) and Na⁺(direct) relative to changes in total protein concentration (Pearson r = -0.69; p < 0.0001). In our setting, for each change of 10 g/L in total protein concentration, a deviation of ~1.3 mmol/L is observed with the Na⁺(indirect) result. Validity of our adjustment equation protein-corrected Na⁺(indirect) = Na⁺(indirect) - 10.53 + (0.1316 × total protein) was demonstrated on a prospective patient cohort.
  
  
  CONCLUSIONS
  As Na⁺(direct) measurements on a blood gas analyzer are not influenced by the total protein concentration in the sample, they should be preferentially used in patients with abnormal protein concentrations. However, as blood gas analyzers are not available at all clinical wards, the implementation of a protein-corrected sodium result might provide an acceptable alternative.
authors.affiliation: 1Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium. 2Department of Laboratory Medicine, Ghent University Hospital, Ghent, Belgium. 3Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium. 4Department of Emergency Medicine, Ghent University Hospital, Ghent, Belgium.
authors.forename: Veronique
authors.initials: V
authors.lastname: Stove
authors.forename: Aster
authors.initials: A
authors.lastname: Slabbinck
authors.forename: Laura
authors.initials: L
authors.lastname: Vanoverschelde
authors.forename: Eric
authors.initials: E
authors.lastname: Hoste
authors.forename: Peter
authors.initials: P
authors.lastname: De Paepe
authors.forename: Joris
authors.initials: J
authors.lastname: Delanghe
mesh_terms: D001774:Blood Chemical Analysis / Q000592:standards*; D001784:Blood Gas Analysis / Q000592:standards*; D004636:Emergency Service, Hospital; D006801:Humans; D007019:Hypoproteinemia / Q000097:blood*; D007362:Intensive Care Units; D010865:Pilot Projects; D011446:Prospective Studies; D012189:Retrospective Studies; D012964:Sodium / Q000097:blood*
chemical_list: D012964:Sodium