Tuesday, June 3, 2025

Numbers in calculated Posm formula

Q: Why we multiply Na by 2 in the formula in calculated Plasma osmolalilty whose formula is 2  x  Plasma Na (mEq/L) + [Glucose]/18 + Blood urea nitrogen(BUN)/2.8 ?


Answer: 

The osmolal gap is calculated by subtracting the calculated serum osmolality from the measured serum osmolality. 

High osmolal gap i.e., above 10 mOsm/kg signifies the presence of unmeasured osmoles, like alcohols (ethanol, methanol, isopropanol, or ethylene glycol.) 

The formula for Calculated Posm  =  2  x  Plasma Na (mEq/L) + [Glucose]/18 + Blood urea nitrogen/2.8

Sodium is multiplied by 2 to count for accompanying anions - chloride and bicarbonate.

Glucose is divided by 18 and BUN is divided by 2.8 to convert units of mg/dL into mmol/L. Thats why the corrections for glucose and blood urea nitrogen are not required in countries that report labs in mmol/L.


#laboratory-scienr
#electrolytes


References:

1. Rose BD, Post TW. Clinical Physiology of Acid-Base and Electrolyte Disorders, 5th ed, McGraw-Hill, New York 2001. p.607.

2. DiNubile MJ. Serum osmolality (letter). N Engl J Med 1984; 310:1609.

3. García-Morales EJ, Cariappa R, Parvin CA, et al. Osmole gap in neurologic-neurosurgical intensive care unit: Its normal value, calculation, and relationship with mannitol serum concentrations. Crit Care Med 2004; 32:986.

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