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Title: Comparing the effect of Hypoalbuminemia on Sodium measured by Indirect versus Direct Ion Selective Electrode Method
Authors: Athar Iqbal Paracha, Zujaja Hina Haroon, Muhammad Aamir, Saima Bashir, Afshan Bibi, Haroon Javaid
Journal: Pakistan Armed Forces Medical Journal (PAFMJ)
Publisher: Army Medical College, Rawalpindi.
Country: Pakistan
Year: 2023
Volume: 73
Issue: 1
Language: English
DOI: 10.51253/pafmj.v73i1.6744
Keywords: HypoalbuminemiaIon selective electrode (ISE)Serum sodium measurement
Objective: To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method.
Study Design: Cross-sectional study
Place and Duration of Study: Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi Pakistan, from Jan to Mar 2021.
Methodology: Patients of either gender, aged 18 to 70 years, who were admitted to the Intensive Care Unit of Combined Military Hospital, Rawalpindi, were selected. A total of 200 blood samples were collected in a gel tube. Serum samples were analyzed for albumin and sodium within two hours of sample collection. Sodium levels were measured concurrently by both direct and indirect ISE methods. The difference in results between these two techniques was studied.
Results: Hypoalbuminemia was detected in 176(88%) patients, while 24(12%) had normal albumin levels. In Hypoalbuminemic patients, serum sodium measurements were higher using the indirect ISE method(134.07±5.55) compared to the direct ISE method (130.95±6.04); the difference between the two techniques was statistically significant (p-value <0.001).Pearson correlation coefficient (r-value = -0.86, p-value <0.001) revealed a symmetrical increase in differences between the two methods as the albumin level decreased.
Conclusion: In Hypoalbuminemic patients, the indirect ISE method gave falsely raised results of serum sodium. In such patients, serum sodium measurement by the Direct ISE method offers more accurate and consistent electrolyte results.
To evaluate the effect of low serum Albumin levels on serum sodium measurement when analyzed by the indirect Ion Selective Electrode (ISE) method and to compare the results with the direct Ion selective electrode (ISE) method.
Cross-sectional study conducted at the Department of Chemical Pathology, Armed Forces Institute of Pathology, Rawalpindi, Pakistan, from January to March 2021. 200 blood samples were collected from critically ill patients admitted to the Intensive Care Unit. Serum samples were analyzed for albumin and sodium concurrently by both direct and indirect ISE methods within two hours of collection. Statistical analysis included paired t-test and Pearson correlation.
graph TD; A["Sample Collection"] --> B["Serum Separation"]; B --> C["Concurrent Analysis"]; C --> D["Indirect ISE Measurement"]; C --> E["Direct ISE Measurement"]; D --> F["Data Analysis"]; E --> F; F --> G["Conclusion"];
The indirect ISE method can lead to falsely elevated serum sodium results in hypoalbuminemic patients, potentially misclassifying hyponatremic patients as normonatremic. This bias is consistent with previous studies. The direct ISE method is unaffected by variations in plasma protein levels and provides more accurate sodium measurements in such cases. The difference between the methods exceeded the CLIA acceptable error limit (±4 mmol/L) in patients with albumin levels below 25 g/L.
Hypoalbuminemia was detected in 88% of patients. In hypoalbuminemic patients, serum sodium measurements were significantly higher using the indirect ISE method (134.07±5.55) compared to the direct ISE method (130.95±6.04) (p<0.001). A significant negative linear correlation (r=-0.86, p<0.01) was found between albumin levels and the difference between the two methods, indicating that as albumin levels decreased, the difference between the methods increased.
In hypoalbuminemic patients, the indirect ISE method yields falsely raised serum sodium results. The direct ISE method offers more accurate and consistent electrolyte results in these patients. It is recommended to use the direct ISE method for serum sodium measurement in patients with low albumin levels, especially those below 25 g/L. Laboratory staff should be aware of the impact of albumin on indirect ISE sodium measurements.
1. Hypoalbuminemia was detected in 176 (88%) of the 200 patients studied.
2. The mean serum sodium measurement in hypoalbuminemic patients was 134.07±5.55 mmol/L by the indirect ISE method and 130.95±6.04 mmol/L by the direct ISE method.
3. A Pearson correlation coefficient of r=-0.86 was found between albumin levels and the difference between the two measurement methods.
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