{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,4]],"date-time":"2026-08-04T04:05:41Z","timestamp":1785816341946,"version":"3.56.0"},"reference-count":48,"publisher":"Elsevier BV","license":[{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/tdm\/userlicense\/1.0\/"},{"start":{"date-parts":[[2025,6,1]],"date-time":"2025-06-01T00:00:00Z","timestamp":1748736000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.elsevier.com\/legal\/tdmrep-license"},{"start":{"date-parts":[[2024,12,2]],"date-time":"2024-12-02T00:00:00Z","timestamp":1733097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["elsevier.com","sciencedirect.com"],"crossmark-restriction":true},"short-container-title":["American Journal of Medicine Open"],"published-print":{"date-parts":[[2025,6]]},"DOI":"10.1016\/j.ajmo.2024.100081","type":"journal-article","created":{"date-parts":[[2024,12,7]],"date-time":"2024-12-07T16:40:59Z","timestamp":1733589659000},"page":"100081","update-policy":"https:\/\/doi.org\/10.1016\/elsevier_cm_policy","source":"Crossref","is-referenced-by-count":2,"special_numbering":"C","title":["Hyponatremia with an Osmolar Gap, Pseudohyponatremia or Hyper-Osmolar Hyponatremia?"],"prefix":"10.1016","volume":"13","author":[{"given":"Leonardo Pozo","family":"Garcia","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Livia","family":"Frost","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8274-6786","authenticated-orcid":false,"given":"Bryan M.","family":"Tucker","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"78","reference":[{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0001","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1016\/j.arr.2012.04.006","article-title":"Prevalence of hyponatremia on geriatric wards compared to other settings over four decades: a systematic review","volume":"12","author":"Mannesse","year":"2013","journal-title":"Ageing Res Rev"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0002","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1186\/s13613-016-0124-x","article-title":"Long-term changes in dysnatremia incidence in the ICU: a shift from hyponatremia to hypernatremia","volume":"6","author":"Oude Lansink-Hartgring","year":"2016","journal-title":"Ann Intensive Care"},{"issue":"7 Suppl 1","key":"10.1016\/j.ajmo.2024.100081_bib0003","doi-asserted-by":"crossref","first-page":"S30","DOI":"10.1016\/j.amjmed.2006.05.005","article-title":"Incidence and prevalence of hyponatremia","volume":"119","author":"Upadhyay","year":"2006","journal-title":"Am J Med"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0004","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1093\/ckj\/sfaa087","article-title":"Iso-osmolar hyponatremia from polyethylene glycol","volume":"14","author":"Tucker","year":"2021","journal-title":"Clin Kidney J"},{"issue":"3","key":"10.1016\/j.ajmo.2024.100081_bib0005","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1001\/jama.2022.11176","article-title":"Diagnosis AND MANAGEMENT OF HYPONATREMIA: A REview","volume":"328","author":"Adrogue","year":"2022","journal-title":"JAMA,"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0006","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1001\/archinte.159.4.333","article-title":"Hyponatremia, hyposmolality, and hypotonicity: tables and fables","volume":"159","author":"Oster","year":"1999","journal-title":"Arch Intern Med,"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0007","doi-asserted-by":"crossref","first-page":"589","DOI":"10.1093\/jalm\/jfab125","article-title":"Interference in ion-selective electrodes due to proteins and lipids","volume":"7","author":"Datta","year":"2022","journal-title":"The Journal of Applied Laboratory Medicine"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0008","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1080\/17843286.2018.1474018","article-title":"Management of electrolyte disorders: also the method matters!","volume":"74","author":"Delanghe","year":"2019","journal-title":"Acta Clin Belg"},{"issue":"8","key":"10.1016\/j.ajmo.2024.100081_bib0009","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1016\/0026-0495(69)90085-7","article-title":"Utility of expressing serum sodium per unit of water in assessing hyponatremia","volume":"18","author":"Waugh","year":"1969","journal-title":"Metabolism"},{"issue":"3","key":"10.1016\/j.ajmo.2024.100081_bib0010","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1093\/clinchem\/31.3.482","article-title":"Ion-selective electrodes for sodium and potassium: a new problem of what is measured and what should be reported","volume":"31","author":"Maas","year":"1985","journal-title":"Clin Chem"},{"issue":"12","key":"10.1016\/j.ajmo.2024.100081_bib0011","doi-asserted-by":"crossref","DOI":"10.3390\/jcm12124076","article-title":"Pseudohyponatremia: mechanism, diagnosis, clinical associations and management","volume":"12","author":"Aziz","year":"2023","journal-title":"J Clin Med"},{"issue":"10","key":"10.1016\/j.ajmo.2024.100081_bib0012","doi-asserted-by":"crossref","first-page":"1483","DOI":"10.1172\/JCI103199","article-title":"The displacement of serum water by the lipids of hyperlipemic serum; a new method for the rapid determination of serum water","volume":"34","author":"Albrink","year":"1955","journal-title":"J Clin Invest"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0013","doi-asserted-by":"crossref","first-page":"e117","DOI":"10.1515\/cclm-2019-0931","article-title":"Disagreement between direct and indirect potentiometric Na+ determination in infancy and childhood","volume":"58","author":"Milani","year":"2020","journal-title":"Clin Chem Lab Med"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0014","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1159\/000351804","article-title":"Spurious electrolyte disorders: a diagnostic challenge for clinicians","volume":"38","author":"Liamis","year":"2013","journal-title":"Am J Nephrol"},{"issue":"Pt 1","key":"10.1016\/j.ajmo.2024.100081_bib0015","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1258\/0004563021901586","article-title":"Effect of low protein concentration on serum sodium measurement: pseudohypernatraemia and pseudonormonatraemia!","volume":"39","author":"Lang","year":"2002","journal-title":"Ann Clin Biochem"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0016","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1515\/cclm-2016-0401","article-title":"Prevalence of pseudonatremia in a clinical laboratory - role of the water content","volume":"55","author":"Langelaan","year":"2017","journal-title":"Clin Chem Lab Med"},{"issue":"15","key":"10.1016\/j.ajmo.2024.100081_bib0017","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1056\/NEJMcps031078","article-title":"Clinical problem-solving. Mind the gap","volume":"349","author":"Turchin","year":"2003","journal-title":"N Engl J Med"},{"key":"10.1016\/j.ajmo.2024.100081_bib0018","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.ejim.2015.11.022","article-title":"Ten common pitfalls in the evaluation of patients with hyponatremia","volume":"29","author":"Filippatos","year":"2016","journal-title":"Eur J Intern Med"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0019","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1373\/clinchem.2005.054981","article-title":"Effects of hyperlipidemia on plasma sodium, potassium, and chloride measurements by an indirect ion-selective electrode measuring system","volume":"52","author":"Dimeski","year":"2006","journal-title":"Clin Chem"},{"issue":"3","key":"10.1016\/j.ajmo.2024.100081_bib0020","doi-asserted-by":"crossref","first-page":"305","DOI":"10.1006\/mchj.1996.1469","article-title":"A clarifying solution for hypertriglyceridemic serums","volume":"57","author":"Artiss","year":"1997","journal-title":"Microchemical journal"},{"key":"10.1016\/j.ajmo.2024.100081_bib0021","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.cca.2012.12.029","article-title":"Lipaemia: causes, consequences and solutions","volume":"418","author":"Walker","year":"2013","journal-title":"Clin Chim Acta"},{"issue":"3","key":"10.1016\/j.ajmo.2024.100081_bib0022","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/0002-9343(89)90302-1","article-title":"Pseudohyponatremia: a reappraisal","volume":"86","author":"Weisberg","year":"1989","journal-title":"Am J Med"},{"issue":"5","key":"10.1016\/j.ajmo.2024.100081_bib0023","doi-asserted-by":"crossref","first-page":"F1652","DOI":"10.1152\/ajprenal.00493.2006","article-title":"A new method for determining plasma water content: application in pseudohyponatremia","volume":"292","author":"Nguyen","year":"2007","journal-title":"Am J Physiol Renal Physiol"},{"issue":"7","key":"10.1016\/j.ajmo.2024.100081_bib0024","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/0165-9936(87)87074-7","article-title":"Severe hyperlipidemia, an analytical problem: enzymic clearing, a simple solution","volume":"6","author":"Artiss","year":"1987","journal-title":"TrAC Trends in Analytical Chemistry"},{"issue":"12","key":"10.1016\/j.ajmo.2024.100081_bib0025","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.1016\/j.amjmed.2017.08.018","article-title":"The hyperlipidemia effect: pseudohyponatremia in pancreatic cancer","volume":"130","author":"Adashek","year":"2017","journal-title":"Am J Med"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0026","doi-asserted-by":"crossref","first-page":"516","DOI":"10.5858\/2010-0018-RS.1","article-title":"Pseudohyponatremia revisited: a modern-day pitfall","volume":"135","author":"Fortgens","year":"2011","journal-title":"Arch Pathol Lab Med"},{"issue":"7","key":"10.1016\/j.ajmo.2024.100081_bib0027","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1136\/jcp.36.7.834","article-title":"Pseudohyponatremia and hyperviscosity","volume":"36","author":"Nanji","year":"1983","journal-title":"J Clin Pathol"},{"key":"10.1016\/j.ajmo.2024.100081_bib0028","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.plabm.2017.02.001","article-title":"Frequency and causes of lipemia interference of clinical chemistry laboratory tests","volume":"8","author":"Mainali","year":"2017","journal-title":"Pract Lab Med"},{"issue":"6","key":"10.1016\/j.ajmo.2024.100081_bib0029","doi-asserted-by":"crossref","first-page":"612","DOI":"10.1093\/alcalc\/35.6.612","article-title":"Mechanisms of hyponatraemia in alcohol patients","volume":"35","author":"Liamis","year":"2000","journal-title":"Alcohol Alcohol"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0030","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1097\/MPA.0000000000001192","article-title":"Pseudohyponatremia in hypertriglyceridemia-induced acute pancreatitis: a tool for diagnosis rather than merely a laboratory error?","volume":"48","author":"Wang","year":"2019","journal-title":"Pancreas"},{"key":"10.1016\/j.ajmo.2024.100081_bib0031","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1016\/j.cca.2021.05.032","article-title":"Preventing pseudohyponatremia: Intralipid(R)-based lipemia cutoffs for sodium are inappropriate","volume":"520","author":"Koch","year":"2021","journal-title":"Clin Chim Acta"},{"issue":"3","key":"10.1016\/j.ajmo.2024.100081_bib0032","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1373\/jalm.2018.028720","article-title":"Prevalence of clinically significant differences in sodium measurements due to abnormal protein concentrations using an indirect ion-selective electrode method","volume":"4","author":"Katrangi","year":"2019","journal-title":"J Appl Lab Med"},{"issue":"8161","key":"10.1016\/j.ajmo.2024.100081_bib0033","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/S0140-6736(80)90705-9","article-title":"Misleading hyponatraemia in hyperlipaemic states","volume":"1","author":"Ionescu-Tirgoviste","year":"1980","journal-title":"Lancet"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0034","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1007\/s004670050430","article-title":"A bridge over troubled water...mixed water and electrolyte disorders","volume":"12","author":"Ichikawa","year":"1998","journal-title":"Pediatr Nephrol"},{"issue":"02","key":"10.1016\/j.ajmo.2024.100081_bib0035","doi-asserted-by":"crossref","first-page":"142","DOI":"10.4172\/2167-7956.1000142","article-title":"A study on effect of lipemia on electrolyte measurement by direct ion selective electrode method","volume":"5","author":"Sen","year":"2016","journal-title":"J Biomol Res Ther"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0036","first-page":"683","article-title":"A simple and precise method of determining true sodium, potassium, and chloride concentrations in hyperlipemia","volume":"88","author":"Steffes","year":"1976","journal-title":"J Lab Clin Med"},{"key":"10.1016\/j.ajmo.2024.100081_bib0037","first-page":"1","article-title":"Asparaginase-induced pseudohyponatremia, a case-driven working strategy in pediatric patients","author":"Evenepoel","year":"2021","journal-title":"Acta Clin Belg"},{"issue":"8","key":"10.1016\/j.ajmo.2024.100081_bib0038","doi-asserted-by":"crossref","first-page":"1435","DOI":"10.1093\/clinchem\/27.8.1435","article-title":"Determination of sodium with ion-selective electrodes","volume":"27","author":"Levy","year":"1981","journal-title":"Clin Chem"},{"issue":"4","key":"10.1016\/j.ajmo.2024.100081_bib0039","doi-asserted-by":"crossref","first-page":"233","DOI":"10.4103\/0972-5229.180044","article-title":"Are sodium and potassium results on arterial blood gas analyzer equivalent to those on electrolyte analyzer?","volume":"20","author":"Gupta","year":"2016","journal-title":"Indian J Crit Care Med"},{"issue":"1","key":"10.1016\/j.ajmo.2024.100081_bib0040","doi-asserted-by":"crossref","first-page":"35","DOI":"10.5005\/jp-journals-10071-23110","article-title":"Interchangeability of sodium and potassium result values of arterial blood gas with laboratory analyzer: narrative review","volume":"23","author":"Ustundag","year":"2019","journal-title":"Indian J Crit Care Med"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0041","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1530\/EJE-19-0101","article-title":"The challenges of sodium measurements: indirect versus direct ion-selective method","volume":"181","author":"Refardt","year":"2019","journal-title":"Eur J Endocrinol"},{"issue":"9","key":"10.1016\/j.ajmo.2024.100081_bib0042","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s12098-013-0977-z","article-title":"A comparative study on reliability of point of care sodium and potassium estimation in a pediatric intensive care unit","volume":"80","author":"Chhapola","year":"2013","journal-title":"Indian J Pediatr"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0043","doi-asserted-by":"crossref","first-page":"97","DOI":"10.3109\/00365513.2014.981854","article-title":"Comparison of blood gas, electrolyte and metabolite results measured with two different blood gas analyzers and a core laboratory analyzer","volume":"75","author":"Uyanik","year":"2015","journal-title":"Scand J Clin Lab Invest"},{"issue":"2","key":"10.1016\/j.ajmo.2024.100081_bib0044","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1055\/s-0040-1713690","article-title":"Discrepancies in electrolyte measurements by direct and indirect ion selective electrodes due to interferences by proteins and lipids","volume":"12","author":"Chopra","year":"2020","journal-title":"J Lab Physicians"},{"issue":"8","key":"10.1016\/j.ajmo.2024.100081_bib0045","doi-asserted-by":"crossref","first-page":"1473","DOI":"10.1016\/j.ajem.2016.04.037","article-title":"Comparison of serum sodium levels measured by blood gas analyzer and biochemistry autoanalyzer in patients with hyponatremia, eunatremia, and hypernatremia","volume":"34","author":"Solak","year":"2016","journal-title":"Am J Emerg Med"},{"issue":"7","key":"10.1016\/j.ajmo.2024.100081_bib0046","doi-asserted-by":"crossref","first-page":"1187","DOI":"10.1515\/CCLM.2011.185","article-title":"Interchangeability of blood gas, electrolyte and metabolite results measured with point-of-care, blood gas and core laboratory analyzers","volume":"49","author":"Leino","year":"2011","journal-title":"Clin Chem Lab Med"},{"issue":"Suppl 2","key":"10.1016\/j.ajmo.2024.100081_bib0047","doi-asserted-by":"crossref","first-page":"i1","DOI":"10.1093\/ndt\/gfu040","article-title":"Clinical practice guideline on diagnosis and treatment of hyponatraemia","volume":"29","author":"Spasovski","year":"2014","journal-title":"Nephrol Dial Transplant"},{"issue":"10","key":"10.1016\/j.ajmo.2024.100081_bib0048","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1515\/CCLM.2000.159","volume":"38","author":"Burnett","year":"2000","journal-title":"Clin Chem Lab Med"}],"container-title":["American Journal of Medicine Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2667036424000189?httpAccept=text\/xml","content-type":"text\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.elsevier.com\/content\/article\/PII:S2667036424000189?httpAccept=text\/plain","content-type":"text\/plain","content-version":"vor","intended-application":"text-mining"}],"deposited":{"date-parts":[[2025,6,7]],"date-time":"2025-06-07T06:23:50Z","timestamp":1749277430000},"score":1,"resource":{"primary":{"URL":"https:\/\/linkinghub.elsevier.com\/retrieve\/pii\/S2667036424000189"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6]]},"references-count":48,"alternative-id":["S2667036424000189"],"URL":"https:\/\/doi.org\/10.1016\/j.ajmo.2024.100081","relation":{},"ISSN":["2667-0364"],"issn-type":[{"value":"2667-0364","type":"print"}],"subject":[],"published":{"date-parts":[[2025,6]]},"assertion":[{"value":"Elsevier","name":"publisher","label":"This article is maintained by"},{"value":"Hyponatremia with an Osmolar Gap, Pseudohyponatremia or Hyper-Osmolar Hyponatremia?","name":"articletitle","label":"Article Title"},{"value":"American Journal of Medicine Open","name":"journaltitle","label":"Journal Title"},{"value":"https:\/\/doi.org\/10.1016\/j.ajmo.2024.100081","name":"articlelink","label":"CrossRef DOI link to publisher maintained version"},{"value":"article","name":"content_type","label":"Content Type"},{"value":"\u00a9 2024 The Author(s). Published by Elsevier Inc.","name":"copyright","label":"Copyright"}],"article-number":"100081"}}