Validation of a simple formula for calculation of serum chloride with estimated value using ion selective electrode

Authors

  • K Manisha
  • Ashok Prabhu
  • K Sowndarya
  • K Sudha

DOI:

https://doi.org/10.51248/.v41i2.786

Keywords:

Calculated chloride, Fasting Blood Sugar (FBS), Random Blood Sugar(RBS), serum electrolytes

Abstract

Introduction and Aim: The maintenance of fluid balance in the intracellular and extracellular compartmentsis by two major electrolytes, namelysodium and chloride.  An increase in sodium is associated with an increase in chloride level and vice versa. The normal reference ranges of sodium and chloride in blood differ by 40mmol/L.On this basis, chloride values can be calculated manually by subtracting 40 from the estimated sodium value.

 

Methods: The study population included 150 normal subjects and 150 diabetic patients.Sodium and chloride, as estimated by the ISE method, were noted in75 random and fasting samples of diabetic group and non-diabetic group. Chloride values were calculated by the new formula(Serumchloride=Serumsodium-40). Mean values of chloride obtained by estimation and calculation were then compared in both diabetics and normal controls. Correlation analysis of estimated chloride and calculated chloride was done by Pearson’s correlation.

 

Results: Chloride determined by the ISE method showed a statistically significant positive correlation with calculated value both in normal and diabetic groups. Further,estimated chloride and calculated chloride values were comparable within the groups in controls and diabetics irrespective of the type of sample collected, ther > 0.95, p=0.0001 in fasting samples of both groups and r = 0.899, p=0.0001 in random samples of both groups. The percentage error calculated between fasting and random samples of both the groups was negligible (less than 1%) ,clearly indicating the accuracy and reliability of the value obtained by using the new simple formula for chloride estimation.

 

Conclusion: On the availability of estimated sodium, chloride values can be calculated by subtracting forty from the same. The values so obtained are reliable in normal as well as the diabetic state where dysnatremia is common.

Author Biographies

K Manisha

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal,  Karnataka, India

Ashok Prabhu

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal,  Karnataka, India

K Sowndarya

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal,  Karnataka, India

K Sudha

Department of Biochemistry, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal,  Karnataka, India

References

Corey, H.E. The anion gap:studies in the nephrotic syndrome anddiabetic ketoacidosis. J Lab Clin Med. 2006; 147: 121-125.

Oh, M.S., Carroll, H.J., Uribarri, J. Mechanism of normochloremic and hyperchloremic acidosis in diabetic ketoacidosis. Nephron. 1990;54:1-6.

Haterill,M.,Waggie, Z., Purves, L., Reynolds, L., Argent, A. Mortality and the nature of metabolic acidosis in children with shock. Intensive care Med. 2003; 29:286-291.

Nasri, H., Rafiean, K. M. Diabetes mellitus and renal failure: Prevention and management. J Res Med Sci. 2015;20(11): 1112-1120.

Matz, R. Hyponatremia: evaluating the correction factor for hyperglycemia.Am J Med. 2000;108:180-181.

Burnett, R.W, Covington, A.K., Fogh-Andersen, N., Külpmann, W.R., Lewenstam, A., Maas, A.H., et al., Recommendations for measurement of and conventions for reporting sodium and potassium by ion-selective electrodes in undiluted serum, plasma or whole blood. International Federation of Clinical Chemistry and Laboratory Medicine (IFCC). IFCC Scientific Division Working Group on Selective Electrodes. Clin Chem Lab Med. 2000;38:1065-1071.

Sudha, K., Aradhana, M., Afzal,A., Charu, Y.Validation of Freidwalds formula in pre and postmenopausal women: an Indian perspective study. Biomedicine. 2017;37(1):026-031.

Reshma, K., Sudha, K., Mamatha, S. Association of prostate disorders with renal dysfunction: Role of biochemical markers. Int J Pharm Bio Sci 2014;5(4):(B) 704-708.

Khalil, A.H.S., Moody, G.J., Thomas, J.D.R. Ion selective electrode determination of sodium and potassium in blood and urine. Clinical Analysis and Analytical Biochemistry. 1986;19(17-18):1809-1830.

Burnett, R.W., Covington, A.K., Foqh, A. N., Kulpmann, W.R.,Lewenstam, A., Maas, A.H. J., et al.,Use of ion selective electrode for blood electrolyte analysis. Recommendations for nomenclature, definitions and conventions. Clin Chem Lab Med2000;38(4):363-370.

Caduff, A., Lutz, H.U. Dynamics of blood electrolytes in repeated hyper and/or hypo glycaemic events in patients with type 1 diabetes. Diabetologia. 2011; 54:2678-2689.

Khalid, Al-R., Khalid, S. Correlation between serum electrolytes and fasting glucose and Hb1Ac in Saudi Diabetic Patients. Biol Trace Elem Res.2011; 144:463-468.

Khan, R.N., Saba, F., Kausar, S.F., Siddiqui, M.H. Pattern of electrolyte imbalance in Type 2 diabetes patients: Experience from a tertiary care hospital. Pak J Med Sci. 2019;35(3):797-801.

Vader, H.L., Vink, C.L.J. The influence of viscosity on dilutionmethods: Its problems in the determination of serum sodium.ClinChim Acta. 1975: 65; 379-388.

Fischman, R.A., Fairclough, G.F., Cheigh, J.S. Iodide and negativeanion gap. N Engl J Med.1978; 29:1035-1036.

Wacks, I., Oster, J.R., Perez, G.O., Kett, D.H. Spurious hyperchloremiaandhyperbicarbonatemia in a patient receiving pyridostigminebromide therapy for myasthenia gravis. Am JKidney Dis.1990;16: 76-79.

Kraut, J.A., Madias,E.N.Serum anion gap: its uses and limitations in clinical medicine. Clin J Am Soc Nephrol, 2007; 2: 162-174.

Downloads

Published

2021-07-07

How to Cite

1.
Manisha K, Prabhu A, Sowndarya K, Sudha K. Validation of a simple formula for calculation of serum chloride with estimated value using ion selective electrode. Biomedicine [Internet]. 2021Jul.7 [cited 2021Jul.24];41(2):223-6. Available from: https://biomedicineonline.org/index.php/home/article/view/786

Issue

Section

Original Research Articles