Published online May 7, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1404-e1407 (doi:10.1542/peds.2006-2554)
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EXPERIENCE & REASON

Serum Osmolal Gap in Patients With Idiopathic Nephrotic Syndrome and Severe Edema

Gaurav Kapur, MD, Rudolph P. Valentini, MD, Abubakr A. Imam, MD, Amrish Jain, MD and Tej K. Mattoo, MD, FRCP

Division of Nephrology and Hypertension, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit, Michigan

ABSTRACT

Pseudohyponatremia in idiopathic nephrotic syndrome with severe edema is attributed to hyperlipidemia that results in displacement of a portion of water phase of plasma. Current methods of measurement of serum electrolytes are unaffected by hyperlipidemia. In this report we demonstrate that patients with idiopathic nephrotic syndrome with severe edema and true hyponatremia may have an increased rather than normal osmolal gap. We believe that this could be secondary to non-Na+ and non-K+ osmoles in response to plasma-volume contraction secondary to hypoalbuminemia. This observation has implications for management of severe edema in such patients, because fluid restriction could increase their risk for pre–renal failure.

Key Words: nephrotic syndrome • osmolal gap • hyponatremia • pre–renal failure

Abbreviations: INS, idiopathic nephrotic syndrome • CHF, congestive heart failure • SUN, serum urea nitrogen

Accepted Nov 29, 2006.