Abstract
The key message from the 1958 Edelman study states that combinations of external gains or losses of sodium, potassium and water leading to an increase of the fraction (total body sodium plus total body potassium) over total body water will raise the serum sodium concentration ([Na]S), while external gains or losses leading to a decrease in this fraction will lower [Na]S. A variety of studies have supported this concept and current quantitative methods for correcting dysnatremias, including formulas calculating the volume of saline needed for a change in [Na]S are based on it. Not accounting for external losses of sodium, potassium and water during treatment and faulty values for body water inserted in the formulas predicting the change in [Na]S affect the accuracy of these formulas. Newly described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids. The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying. Currently, monitoring of serum sodium concentration remains a critical step during treatment of dysnatremias.
Highlights
Dysnatremias contribute to morbidity, mortality, and high medical costs [1, 2]
Edelman Revisited of the methodology of the Edelman study, its main findings, its application to the analysis of pathophysiology and to the methods of management of dysnatremias, and the opportunities created by newer findings
If the same patient had developed hypovolemic hyponatremia with a volume loss of 3.33 L and a [Na]S of 100 mmol/L and received the same load of sodium (513 mmol) in 3.33 L of isotonic saline (154 mmol/L), the final [Na]S will be 110.3 mmol/L using of the Adrogué-Madias formula and 111.3 mmol/L if the infused saline volume is not included in the calculation
Summary
Described factors potentially affecting the change in [Na]S during treatment of dysnatremias include the following: (a) exchanges during development or correction of dysnatremias between osmotically inactive sodium stored in tissues and osmotically active sodium in solution in body fluids; (b) chemical binding of part of body water to macromolecules which would decrease the amount of body water available for osmotic exchanges; and (c) genetic influences on the determination of sodium concentration in body fluids The effects of these newer developments on the methods of treatment of dysnatremias are not well-established and will need extensive studying.
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