1. Harmonization of Blood Electrolyte Concentration Results: Are Values 'Watered Down'?
- Author
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Moran, Robert F.
- Subjects
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ION selective electrodes , *PHYSICIANS' attitudes , *BLOOD volume , *CEREBROSPINAL fluid , *ELECTROLYTES - Abstract
Analysis of physiologic specimens such as blood, urine, and cerebrospinal fluid for electrolytes, especially sodium and potassium, began more than a century ago as physician-biochemists tried objective ways of assessing the most basic aspects of physiology-water-electrolyte and acid/base balance. Of the types of specimens, whole blood and the liquid serum or plasmaI separated from the formed elementsII became the medium in which these ions were measured, first with gravimetry, later by emission/absorption spectroscopy. Each reported results as a concentration per volume of plasma (mg/dL or mEq/L). Expected or normal ranges were established, which in the case of sodium were quite narrow relative to the average (140 +/- 5mmpl/L). The advent of ion selective electrode (ISE) technology made it possible to measure them directly in whole blood with minimal specimen preparation, but ISE's gave results consistently higher than the established norms by an amount equal to the 'normal' range. Since most initial evaluative blood work on a patient admitted to a hospital or clinic includes the electrolytes, physicians had become accustomed to the values and looked at the 'high' ISE values as 'errors'. In fact, it was the ISE that was measuring what the body's sensors detected and they specifically allowed differentiation in certain serious but less common disorders, a fact that was obscured by the inherent difference in values on normal subjects. Technically the matter is simple (though there are some complex nuances) - the electrolytes are dissolved in the water fraction of the plasma, not the plasma as a whole. Changing well established physician perspectives, however, was (and is) a different story. And now the rest of the story.... [ABSTRACT FROM AUTHOR]
- Published
- 2024