Osmosis, osmometry, and osmoregulation

Serum and urine osmolality: 8 hours, 24 hours and 1-month sample stability

OBJECTIVES

The body of literature varies significantly regarding serum and urine osmolality stability. Therefore, our aim was to investigate the stability of serum and urine osmolality at different temperatures (room temperature (RT) 4-8 °C, -20 °C) and time conditions (8 h, 24 h, 1 month).

METHODS

The stability study was conducted following the CRESS guidelines, including 40 serum and urine samples. Samples were aliquoted into three aliquots and stored as follows: primary tube stored at RT for 8 h; two capped aliquots stored at 4-8 °C for 8 h and 24 h; one aliquot stored at -20 °C for 1 month. To minimize imprecision error, serum and urine osmolality were measured by the freezing point depression method in triplicate on OSMOMAT 3000 (Gonotech, Germany) analyzer. Percentage difference (PD%) against baseline measurement was calculated. Deviations were assessed against a reference change value of 5.0%.

RESULTS

The PD% for serum and urine osmolality was below 2.0% for all time/temperature conditions. For serum samples: primary tube after 8 h at RT PD% (95% CI) = 0.0% (-0.3, 0.2%); 8 h at 4-8 °C PD% (95% CI) = -0.4% (-0.7, 0.0%); 24 h at 4-8 °C PD% (95% CI) = -0.7% (-0.7, -0.6%); 1 month at -20 °C PD% (95% CI) = -2.1% (-2.4, -1.5%). For urine samples: after 8 h at RT PD% (95% CI) =0.6% (0.2, 0.9%); 8 h at 4-8 °C PD% (95% CI) = -0.2% (-0.5, 0.1%); 24 h at 4-8 °C PD% (95% CI) = -0.2% (-0.5, 0.0%); 1 month at -20 °C PD% (95% CI) = -2.0% (-3.0, -1.0%).

CONCLUSIONS

Changes in osmolality for tested conditions for serum and urine samples, were within acceptance criteria. Reflex and add-on osmolality testing can be performed within the same day in samples kept at RT for 8 h in primary tube and within 24 h, in aliquoted refrigerated samples, without compromising the reliability of test results. For longer storage, samples should be kept at -20 °C.

Evaluation of the effects of glucose on osmolal gap using freezing point depression and vapor pressure methods

The measurement of serum osmolality, and the calculation of osmolal gap (OG) from a calculated osmolality are widely used in clinical and emergency medicine. In this study, the possible effects of blood glucose on OG were investigated by freezing point depression and vapor pressure methods. The concentrations of sodium, glucose, blood urea nitrogen and osmolalities of 2640 samples were measured. There were two methods for calculating serum osmolality: freezing point depression method (n = 2399) and vapor pressure method (n = 241). The OG was positively associated with glucose in glucose 110-450 mg/dL (r = 0.191, p < 0.001) and glucose > 450 mg/dL (r = 0.372, p < 0.001), but not in glucose < 110 mg/dL (r = 0.017, p = 0.711) in freezing point depression method. However, OG had no correlation with glucose regardless of glucose level in vapor pressure method. In freezing point depression method, compared with the groups of glucose <110 and 110-450 mg/dL, the group with glucose >450 mg/dL had higher OG (p < 0.001) and higher prevalence of OG > 10 mOsm/Kg H₂O (p < 0.001). Our study demonstrated that OG is impacted by increasing blood glucose concentration using freezing point depression method, special attention should be made to blood glucose concentrations when using freezing point depression method to determine OG.

Gradients and dynamics of inner bark and needle osmotic potentials in Scots pine (Pinus sylvestris L.) and Norway spruce (Picea abies L. Karst)

Preconditions of phloem transport in conifers are relatively unknown. We studied the variation of needle and inner bark axial osmotic gradients and xylem water potential in Scots pine and Norway spruce by measuring needle and inner bark osmolality in saplings and mature trees over several periods within a growing season. The needle and inner bark osmolality was strongly related to xylem water potential in all studied trees. Sugar concentrations were measured in Scots pine, and they had similar dynamics to inner bark osmolality. The sucrose quantity remained fairly constant over time and position, whereas the other sugars exhibited a larger change with time and position. A small osmotic gradient existed from branch to stem base under pre-dawn conditions, and the osmotic gradient between upper stem and stem base was close to zero. The turgor in branches was significantly driven by xylem water potential, and the turgor loss point in branches was relatively close to daily minimum needle water potentials typically reported for Scots pine. Our results imply that xylem water potential considerably impacts the turgor pressure gradient driving phloem transport and that gravitation has a relatively large role in phloem transport in the stems of mature Scots pine trees.

Analytical validation and reference intervals for freezing point depression osmometer measurements of urine osmolality in dogs

Urine osmolality (UOsm) is considered the most accurate measure of urine concentration and is used to assess body fluid homeostasis and renal function. We performed analytical validation of freezing point depression measurement of canine UOsm, to establish reference intervals (RIs) and to determine the effect of age, sex, and reproductive status on UOsm in dogs. Clinically healthy dogs ( n = 1,991) were retrospectively selected and stratified in groups by age (young [0-12 mo], adults [13-84 mo], and seniors [>84 mo]), sex (females and males), and reproductive status (intact and neutered). RIs were calculated for each age group. Intra- and inter-assay coefficients of variation were <1% in all cases. Good linearity ( r² = 1, p < 0.001) and recovery (89-98%) were observed. The limit of detection and limit of quantification were zero. Urine specific gravity and UOsm had a highly significant positive correlation ( r = 0.96, p < 0.001) but had inconsistent agreement. The 95% RI for canine UOsm was 369-2,416 mOsm/kg in young and adult dogs, and 366-2,178 mOsm/kg in seniors. Senior dogs had a significantly lower UOsm than young and adult dogs ( p < 0.000). Neutered females had a significantly lower UOsm than intact female dogs ( p < 0.002). These results indicate that the method evaluated is adequate for UOsm measurement and that RIs based on age and reproductive status should be used in dogs.

The Triterpenoid Betulin Protects against the Neuromuscular Effects of Bothrops jararacussu Snake Venom In Vivo

We confirmed the ability of the triterpenoid betulin to protect against neurotoxicity caused by Bothrops jararacussu snake venom in vitro in mouse isolated phrenic nerve-diaphragm (PND) preparations and examined its capability of in vivo protection using the rat external popliteal/sciatic nerve-tibialis anterior (EPSTA) preparation. Venom caused complete, irreversible blockade in PND (40 μg/mL), but only partial blockade (~30%) in EPSTA (3.6 mg/kg, i.m.) after 120 min. In PND, preincubation of venom with commercial bothropic antivenom (CBA) attenuated the venom-induced blockade, and, in EPSTA, CBA given i.v. 15 min after venom also attenuated the blockade (by ~70% in both preparations). Preincubation of venom with betulin (200 μg/mL) markedly attenuated the venom-induced blockade in PND; similarly, a single dose of betulin (20 mg, i.p., 15 min after venom) virtually abolished the venom-induced decrease in contractility. Plasma creatine kinase activity was significantly elevated 120 min after venom injection in the EPSTA but was attenuated by CBA and betulin. These results indicate that betulin given i.p. has a similar efficacy as CBA given i.v. in attenuating the neuromuscular effects of B. jararacussu venom in vivo and could be a useful complementary measure to antivenom therapy for treating snakebite.

Application of osmometry in quality analysis of milk

The aim of this study was to evaluate osmometry as a tool in quality analysis of milk. The osmolality of raw milk, sterilized milk, skimmed UHT (ultra-high temperature-treated) milk, pasteurized milk, standardized UHT milk and fermented milk (Lactococcus lactis culture) was determined by freezing point osmometry. The relationship between osmolality and pH of fermented milk was further investigated during spontaneous fermentation of UHT milk at 37 °C for 48 h. Average osmolality values (mean ± SD) were raw milk-290.2 ± 7.98, sterilized milk-290.2 ± 5.84, skimmed UHT milk-290.8 ± 3.31, pasteurized milk-283.6 ± 2.28, standardized UHT milk-281 ± 4.59 and fermented milk-466.0 ± 17.30 mOsmoles kg(-1). For fresh milk samples, 88 % showed normal osmolality, 8 % were hypo-osmotic and 4 % hyper-osmotic. Fermentation studies revealed a high negative correlation between osmolality and pH, with a correlation coefficient of -97.49 %. Hypo-osmotic milk shows mixing of milk with water along the production chain. Hyper-osmotic milk indicates fermentation of milk at high ambient temperatures or with prolonged storage. It may also reveal adulteration of fresh milk with a soluble substance. Osmolality was highest for fermented milk owing to production of lactic acid during fermentation. This was confirmed by the high negative correlation between osmolality and pH of milk in fermentation studies. Hence the osmolality of fermented milks may be used as an index of the extent of fermentation.

Serum osmolality and effects of water deprivation in captive Asian elephants (Elephas maximus)

Serum from 21 healthy, captive Asian elephants (Elephas maximus) was evaluated by measured and calculated osmolality. Serum osmolality results for this population of Asian elephants had a median of 261 mOsm/kg and an interquartile interval of 258-269 mOsm/kg when measured by freezing point osmometry and a median of 264 mOsm/kg and an interquartile interval of 257-269 mOsm/kg when measured by vapor pressure osmometry. These values are significantly lower than values reported in other mammalian species and have important diagnostic and therapeutic implications. Calculated osmolality produced unreliable results and needs further study to determine an appropriate formula and its clinical application in this species. A 16-hr water deprivation test in 16 Asian elephants induced a small, subclinical, but statistically significant increase in measured serum osmolality. Serum osmolality, blood urea nitrogen, and total protein by refractometer were sensitive indicators of hydration status. Serum osmolality measurement by freezing point or vapor pressure osmometry is a useful adjunct to routine clinical tests in the diagnostic evaluation of elephants.

Osmolal gap in hemodialyzed uremic patients

Osmolality is an expression of the number of particles in a given weight of solvent (mOsm). Measured osmolality is determined by the osmometer, and calculated osmolality is estimated by 2xNa + UN/2.8 + glucose/18. The difference between measured and calculated osmolality is the osmolal gap. The purpose of the present study is to determine the measured and the calculated osmolality and the osmolal gap in hemodialyzed uremic patients, pre- and post-hemodialysis (HD). In 24 uremic patients under regular HD, blood samples pre- and post-HD were collected, and serum osmolality measured (osmometer) and calculated (2xNa + UN/2.8 + glucose/18) and the osmolal gap (measured-calculated osmolality) were determined. Also, the same parameters were determined in 22 healthy subjects (control). According to our findings, the measured osmolality in patients is significantly higher pre- and post-HD in comparison to that of controls, but post-HD is significantly lower than pre-HD. Also, calculated osmolality is significantly higher pre- and post-HD in comparison to that of controls, but the value post-HD is significantly lower than the pre-HD. The osmolal gap of patients pre-HD (11 ± 2.08) and post-HD (7.29 ± 1.94) is significantly higher (P < 0.001) in comparison to that of controls (3.18 ± 1.46); also, the value post-HD is significantly decreased in comparison to the value pre-HD (P < 0.001). Uremic hemodialyzed patients present high measured and calculated osmolality pre-HD that remains high post-HD in comparison to that of controls in spite of the significant decrease post-HD in comparison to that of pre-HD. Also, the osmolal gap is high pre-HD and, in spite of the decrease, remains high post-HD. In comparison to that of controls, the high osmolal gap indirectly indicates the presence of unidentified endogenous osmoles in the serum of uremic patients which partly are removed during HD.

Growth performance and gastrointestinal microbial ecology responses of piglets receiving Saccharomyces cerevisiae fermentation products after an oral challenge with Escherichia coli (K88)

The effects of Saccharomyces cerevisiae fermentation products (YFP) on growth performance and gastrointestinal (GIT) microbial ecology in 90 weanling pigs orally challenged with Escherichia coli K88(+) (ETEC) were investigated. The YFP were an original YFP product (XPC) and a water-suspendable yeast fermentation prototype (WSYFP) from a commercial company. Treatments consisted of a negative control (NC, no in-feed or in-water additive), carbadox (AB, 55 mg of carbadox/kg of feed), XPC (in feed, 0.2%), and WSYFP (in water, 0.5, 1, or 2 g/pig per day), and each was allotted to 5 pens (3 pigs/pen). The diets met the 1998 NRC specifications. Pigs were acclimated to treatments for a 7-d period before an ETEC challenge. On d 8, blood was collected from pigs to determine the baseline packed cell volume (PCV) measurement, and pigs were orally challenged with ETEC. At various time points postchallenge, blood samples were taken, performance measures and fecal consistency scores were recorded, and gut digesta and tissue samples were taken to evaluate GIT morphology, microbial ecology, and metabolites. Preplanned contrasts were used for comparison. Pigs receiving YFP had greater ADFI than NC pigs on d 3 (424 vs. 378 g/d; P = 0.01) and d 7 (506 vs. 458 g/d; P = 0.03) postchallenge. This effect of YFP on ADFI was similar to that of AB on d 3, but pigs receiving AB ate more (576 vs. 506 g/d; P = 0.03) at d 7 than pigs receiving YFP. Pigs exhibited reduced (P < 0.001) PCV upon ETEC challenge; however, pigs receiving additives sustained a greater (P < 0.05) PCV at 72 h compared with the NC group. Compared with the NC pigs, pigs receiving YFP showed a smaller (P < 0.05) number of ileal mucosa adherent ETEC and prevalence of the order Enterobacteriales in the ileal digesta, which corresponded to less (5.09 vs. 6.97 mg/dL; P = 0.03) colonic ammonia on d 7 postchallenge. Most of the indices for ileal digesta bacterial richness and diversity were greater (P < 0.01) for YFP pigs compared with NC pigs. However, results also indicated that the influence of YFP on the piglet intestinal microenvironment might differ when given in feed or water during ETEC challenge. In conclusion, pigs receiving YFP showed a better appetite in the presence of ETEC, which, together with the greater ileal digesta bacteria richness and diversity and decreased ETEC adhering to the mucosa and reduced colonic ammonia, indicates a healthier GIT environment.

The effects of peroral glycerol on plasma osmolarity in diabetic patients and healthy individuals

Glycerol is used as a peroral treatment of increased intraocular and intracranial pressure due to its osmotic effect despite the potential increase in blood pressure and blood glucose. We examined the effects of peroral glycerol in diabetic patients and healthy individuals on blood pressure, capillary glucose, and plasma osmolarity. On two separate days, 15 diabetic patients ingested glycerol in doses of 855 and 1710 mg/kg body weight in a randomised, unmasked sequence. Five healthy individuals ingested a dose of 1710 mg/kg body weight. Mean arterial blood pressure (MAP), capillary glucose (CG) and plasma osmolarity (pOSM) were monitored for 180 min. At baseline, the MAP was comparable between the groups of healthy individuals and diabetic patients (p = 0.55), CG was marginal different (p = 0.06), and pOSM values were significantly different (p = 0.007). Following glycerol ingestion, a transient, non-significant increase occurred in blood pressure. Maximal DeltaCG was approximately 1 mM irrespective of the dose and presence of diabetes (p > 0.1). The pOSM response was analysed with a kinetic model and found independent of the presence of diabetes (p = 0.6). The maximal fitted DeltapOSM was 12.7 and 25.3 mOsm/l in the group of diabetic patients after the low and high dose, respectively, reflecting a dose-response relationship. Nausea, fatigue and headache were common side effects. In conclusion, peroral glycerol had similar effects on blood glucose, MAP and pOSM in the diabetic patients and healthy individuals. Specific precautions should not be implemented when treating diabetic patients with a single dose up to 1.7 g/kg body weight. A peak increase of 8% in the pOSM within 1 hr can be expected from this dose.

Exercise-Associated Hyponatraemia

In 1958, Edelman and colleagues empirically showed plasma sodium concentration ([Na+]p) to be primarily a function of the sum of exchangeable sodium and potassium (E) divided by total body water (TBW). Based on Edelman's equation, Nguyen and Kurtz derived an equation to show how [Na+]p changes as a function of TBW, change in TBW (DeltaTBW), and change in the sum of exchangeable sodium and potassium (DeltaE). Using the Nguyen-Kurtz equation, the present study examines the sensitivity of [Na+]p to these parameters: [Na+]p is very sensitive to DeltaTBW and moderately sensitive to DeltaE, and is modulated by TBW. For example, for a person with 50 L TBW, a net increase of 1L water lowers [Na+]p by 3.2 mEq/L, but for a person with 25 L TBW it lowers [Na+]p by 6.3 mEq/L (assuming initial [Na+]p is 140 mEq/L). In each case, a loss of 159 mEq of sodium plus potassium (roughly equivalent to 1.5 teaspoons of table salt) would be required to produce the same effect as the net increase of 1 L water. The present review demonstrates why fluid overload predominates over electrolyte loss in the aetiology of exercise-associated hyponatraemia (EAH), and why the excretion of electrolyte-dilute urine is highly effective in correcting EAH (nonetheless, loss of sodium and potassium is significant in long events in warm weather). Sports drinks will, if overconsumed, result in hyponatraemia. Administration of a sports drink to an athlete with fluid overload hyponatraemia further lowers [Na+]p and increases fluid overload. Administration of either a sports drink or normal (0.9%) saline increases fluid overload.

Assessment of Fluids and Electrolytes

Bedside evaluation of a patient's intravascular volume status is challenging, even for the seasoned practitioner. There is no single diagnostic test to determine whether a patient is hypovolemic, hypervolemic, or euvolemic. Often, underlying or concomitant disease states, medications, and other therapeutics can make available data difficult to interpret. Therefore, a combination of clinical evaluation, laboratory studies, and other diagnostics are required to make a clinical judgment regarding volume status. Patients who demonstrate alterations in their volume status are likely to have electrolyte abnormalities as well, and assessment of serum electrolyte values and potential therapeutic interventions is a vital piece in caring for critically ill patients.