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The osmolal gap: what has changed?
| Content Provider | Semantic Scholar |
|---|---|
| Author | Whittington, Jodell E. La’ulu, Sonia L. Hunsaker, Joshua J. H. Roberts, William L. |
| Copyright Year | 2010 |
| Abstract | To the Editor: The osmolal gap (OG)1 is calculated in the emergency department (ED) when ingestion of ethylene glycol, methanol, isopropyl alcohol, acetone, or other osmotically active substances are suspected. Serum osmolality is measured and also calculated with the variables serum glucose, sodium, and blood urea nitrogen (BUN) concentrations. The difference between the measured and calculated osmolality is defined as the OG. Boyle et al. (1) recently cautioned against using the OG as a screening tool for toxic-alcohol poisoning. One reason relates to the debate about what constitutes a normal OG and the variations in the range of osmolal gaps (2). To address what constitutes a normal OG, we determined the OG range for healthy subjects and examined data from hospitalized patients by use of several published equations for calculating serum osmolality. After obtaining informed consent, we collected blood from 126 self-reported healthy subjects. The serum osmolality glucose, potassium, sodium, and BUN were within respective reference intervals (Tables 1 and 2). The OG log-transformed parametric reference intervals (central95%) were −8 to 11 mOsm/kg and 3 to 22 mOsm/kg by use of Eqs. 1 and 2, respectively. View this table: Table 1. Reference intervals of measured analytes. View this table: Table 2. Osmolal gaps and osmolality for healthy and ED patients in 1998 and 2007–2009. General equation (2,4) Osm = 2 ( Na + ) + Glucose 18 + BUN 2.8 + EtOH 4.6 (1) Glaser (3) and Krahn and Khajuria [4; see Dorwart's equation] Osm = 1.86 ( Na + ) + Glucose 18 + BUN 2.8 + EtOH 4.6 + 9 (2) Rasouli and Kalantari (5) Osm = 1.897 ( Na + ) + Glucose 18 + BUN 2.8 + EtOH 4.6 + 13.5 (3) Krahn and Khajuria (4) Osm = 1.86 ( Na + + K + ) + 1.15 ( Glucose 18 ) + BUN 2.8 + 1.2 ( EtOH 4.6 ) + 14 (4) Osm = 2 ( Na + ) + 1.15 ( Glucose 18 ) + BUN 2.8 + 1.2 ( EtOH 4.6 ) (5) ED records identified 157 patients in 1998 and 117 patients in 2007–2009 … |
| File Format | PDF HTM / HTML |
| DOI | 10.1373/clinchem.2010.147199 |
| PubMed reference number | 20530730 |
| Journal | Medline |
| Volume Number | 56 |
| Issue Number | 8 |
| Alternate Webpage(s) | http://clinchem.aaccjnls.org/content/clinchem/56/8/1353.full.pdf |
| Alternate Webpage(s) | http://clinchem.aaccjnls.org/content/clinchem/early/2010/06/08/clinchem.2010.147199.full.pdf |
| Alternate Webpage(s) | https://doi.org/10.1373/clinchem.2010.147199 |
| Journal | Clinical chemistry |
| Language | English |
| Access Restriction | Open |
| Content Type | Text |
| Resource Type | Article |
