Published online May 7, 2007
PEDIATRICS Vol. 119 No. 6 June 2007, pp. e1404-e1407 (doi:10.1542/peds.2006-2554)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Kapur, G.
Right arrow Articles by Mattoo, T. K.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Kapur, G.
Right arrow Articles by Mattoo, T. K.
Related Collections
Right arrow Genitourinary Tract
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

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.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?