Plasma Osmolality
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Plasma osmolality measures the body's electrolyte–water balance. There are several methods for arriving at this quantity through measurement or calculation.
Osmolality Molality is a measure of the number of moles of solute in a solution corresponding to 1 kg or 1000 g of solvent. This contrasts with the definition of molarity which is based on a specified volume of solution. A commonly used unit for molali ...
and
osmolarity Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
are measures that are technically different, but functionally the same for normal use. Whereas osmolality (with an "l") is defined as the number of
osmole Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
s (Osm) of solute per
kilogram The kilogram (also kilogramme) is the unit of mass in the International System of Units (SI), having the unit symbol kg. It is a widely used measure in science, engineering and commerce worldwide, and is often simply called a kilo colloquially ...
of
solvent A solvent (s) (from the Latin '' solvō'', "loosen, untie, solve") is a substance that dissolves a solute, resulting in a solution. A solvent is usually a liquid but can also be a solid, a gas, or a supercritical fluid. Water is a solvent for ...
(osmol/kg or Osm/kg), osmolarity (with an "r") is defined as the number of osmoles of solute per
liter The litre (international spelling) or liter (American English spelling) (SI symbols L and l, other symbol used: ℓ) is a metric unit of volume. It is equal to 1 cubic decimetre (dm3), 1000 cubic centimetres (cm3) or 0.001 cubic metre (m3). ...
(L) of
solution Solution may refer to: * Solution (chemistry), a mixture where one substance is dissolved in another * Solution (equation), in mathematics ** Numerical solution, in numerical analysis, approximate solutions within specified error bounds * Soluti ...
(osmol/L or Osm/L). As such, larger numbers indicate a greater concentration of solutes in the plasma.


Measured osmolality (MO)

Osmolality can be measured on an analytical instrument called an
osmometer An osmometer is a device for measuring the osmotic strength of a solution, colloid, or compound. There are several different techniques employed in osmometry: * Vapor pressure osmometers determine the concentration of osmotically active particles ...
. It works on the method of depression of
freezing point The melting point (or, rarely, liquefaction point) of a substance is the temperature at which it changes state from solid to liquid. At the melting point the solid and liquid phase exist in equilibrium. The melting point of a substance depends ...
.


Osmolality versus osmolarity

Osmolarity is affected by changes in water content, as well as temperature and pressure. In contrast, osmolality is independent of temperature and pressure. For a given solution,
osmolarity Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
is slightly less than osmolality, because the total solvent weight (the
divisor In mathematics, a divisor of an integer n, also called a factor of n, is an integer m that may be multiplied by some integer to produce n. In this case, one also says that n is a multiple of m. An integer n is divisible or evenly divisible by ...
used for osmolality) excludes the weight of any solutes, whereas the total solution volume (used for osmolarity) includes solute content. Otherwise, one litre of plasma would be equivalent to one kilogram of plasma, and plasma osmolarity and plasma osmolality would be equal. However, at low concentrations (below about 500 mM), the mass of the solute is negligible compared to the mass of the solvent, and osmolarity and osmolality are very similar. Technically, the terms can be compared as follows: Therefore, bedside calculations are actually in units of
osmolarity Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
, whereas laboratory measurements will provide readings in units of
osmolality Molality is a measure of the number of moles of solute in a solution corresponding to 1 kg or 1000 g of solvent. This contrasts with the definition of molarity which is based on a specified volume of solution. A commonly used unit for molali ...
. In practice, there is almost negligible difference between the absolute values of the different measurements. For this reason, both terms are often used interchangeably, even though they refer to different units of measurement.


Ranges


Human

Normal human
reference range In medicine and health-related fields, a reference range or reference interval is the range or the interval of values that is deemed normal for a physiological measurement in healthy persons (for example, the amount of creatinine in the blood, or ...
of osmolality in plasma is about 275-299 milli-osmoles per kilogram.


Nonhuman

Plasma osmolarity of some reptiles, especial those from a freshwater aquatic environment, may be lower than that of mammals (e.g. < 260 mOsm/L) during favourable conditions. Consequently, solutions osmotically balanced for mammals (e.g., 0.9% normal saline) are likely to be mildly
hypertonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane- ...
for such animals. Many arid species of reptiles and hibernating
uricotelic Metabolic wastes or excrements are substances left over from metabolic processes (such as cellular respiration) which cannot be used by the organism (they are surplus or toxic), and must therefore be excreted. This includes nitrogen compounds, w ...
species allow major elevations of plasma osmolarity (e.g. > 400 mOsm/L) that could be fatal to some mammals. Deep-sea fish have adapted to the extreme hydrostatic pressures of depth through a number of factors, including increasing osmolality, with one of the deepest known fish in the world, the hadal snailfish (''Notoliparis kermadecensis)'' having a recorded muscle osmolality of 991 ± 22 mOsmol/kg, almost four times the osmolality of mammals and three times that of shallow water fish species (typically 350 mOsmol/kg).


Clinical relevance

As
cell membrane The cell membrane (also known as the plasma membrane (PM) or cytoplasmic membrane, and historically referred to as the plasmalemma) is a biological membrane that separates and protects the interior of all cells from the outside environment ( ...
s in general are freely permeable to water, the osmolality of the
extracellular fluid In cell biology, extracellular fluid (ECF) denotes all body fluid outside the cells of any multicellular organism. Total body water in healthy adults is about 60% (range 45 to 75%) of total body weight; women and the obese typically have a lower ...
(ECF) is approximately equal to that of the
intracellular fluid The human body and even its individual body fluids may be conceptually divided into various fluid compartments, which, although not literally anatomic compartments, do represent a real division in terms of how portions of the body's water, solute ...
(ICF). Therefore, plasma osmolality is a guide to intracellular osmolality. This is important, as it shows that changes in ECF osmolality have a great effect on ICF osmolality — changes that can cause problems with normal cell functioning and volume. If the ECF were to become too
hypotonic In chemical biology, tonicity is a measure of the effective osmotic pressure gradient; the water potential of two solutions separated by a partially-permeable cell membrane. Tonicity depends on the relative concentration of selective membrane-imp ...
, water would readily fill surrounding cells, increasing their volume and potentially
lysing Lysis ( ) is the breaking down of the membrane of a cell, often by viral, enzymic, or osmotic (that is, "lytic" ) mechanisms that compromise its integrity. A fluid containing the contents of lysed cells is called a ''lysate''. In molecular bio ...
them (
cytolysis Cytolysis, or osmotic lysis, occurs when a cell bursts due to an osmotic imbalance that has caused excess water to diffuse into the cell. Water can enter the cell by diffusion through the cell membrane or through selective membrane channels ...
). Many poisons, medications and diseases affect the balance between the ICF and ECF, affecting individual cells and homeostasis as a whole. Osmolality of
blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood in the c ...
increases with
dehydration In physiology, dehydration is a lack of total body water, with an accompanying disruption of metabolic processes. It occurs when free water loss exceeds free water intake, usually due to exercise, disease, or high environmental temperature. Mil ...
and decreases with overhydration. In normal people, increased osmolality in the blood will stimulate secretion of
antidiuretic hormone Human vasopressin, also called antidiuretic hormone (ADH), arginine vasopressin (AVP) or argipressin, is a hormone synthesized from the AVP gene as a peptide prohormone in neurons in the hypothalamus, and is converted to AVP. It then travel ...
(ADH). This will result in increased water reabsorption, more concentrated
urine Urine is a liquid by-product of metabolism in humans and in many other animals. Urine flows from the kidneys through the ureters to the urinary bladder. Urination results in urine being excretion, excreted from the body through the urethra. Cel ...
, and less concentrated blood plasma. A low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma. Syndrome of inappropriate ADH secretion occurs when excessive release of antidiuretic hormone results in inappropriately elevated urine osmolality (>100 mOsmol/L) relative to the blood plasma, leading to hyponatraemia. This ADH secretion may occur in excessive amounts from the
posterior pituitary gland The posterior pituitary (or neurohypophysis) is the posterior lobe of the pituitary gland which is part of the endocrine system. The posterior pituitary is not glandular as is the anterior pituitary. Instead, it is largely a collection of axona ...
, or from ectopic sources such as small-cell carcinoma of the lung. Elevation may be associated with stroke mortality.


Calculated osmolarity (CO)

In medical lab reports, this quantity often appears as "Osmo, Calc" or "Osmo (Calc)." According to the international SI unit use the following equation : Calculated osmolarity = 2 Na + Glucose + Urea (all in mmol/L) As Na+ is the major extracellular cation, the sum of osmolarity of all other anions can be assumed to be equal to natremia, hence a+2 ≈ a++ nions To calculate plasma osmolality use the following equation (typical in the US): * = 2[] + [Glucose]/18 + [ BUN ]/2.8 where [Glucose] and [BUN] are measured in mg/dL. If the patient has ingested ethanol, the ethanol level should be included in the calculated osmolarity: * = 2[] + [Glucose]/18 + [ BUN ]/2.8 + [Ethanol]/3.7 Based on the molecular weight of ethanol the divisor should be 4.6 but empiric data shows that ethanol does not behave as an ideal osmole.


Osmolar gap (OG)

The '' osmolar gap'' is the difference between the measured osmolality and the calculated osmolarity. The difference in units is attributed to the difference in the way that blood solutes are measured in the laboratory versus the way they are calculated. The laboratory value measures the freezing point depression, properly called
osmolality Molality is a measure of the number of moles of solute in a solution corresponding to 1 kg or 1000 g of solvent. This contrasts with the definition of molarity which is based on a specified volume of solution. A commonly used unit for molali ...
while the calculated value is given in units of
osmolarity Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
. Even though these values are presented in different units, when there is a small amount of solute compared to total volume of solution, the absolute values of osmolality vs. osmolarity are very close. Often, this results in confusion as to which units are meant. For practical purposes, the units are considered interchangeable. The resulting "osmolar gap" can be thought of as either osmolar or osmolal, since both units have been used in its derivation. Measured osmolality is abbreviated "MO", calculated osmolarity is abbreviated "CO", and the osmolality gap is abbreviated "OG". Clinically the osmolar gap is used to detect the presence of an osmotically active particle that is not normally found in plasma, usually a toxic alcohol such as ethanol, methanol or isopropyl alcohol.


See also

*
Osmotic concentration Osmotic concentration, formerly known as osmolarity, is the measure of solute concentration, defined as the number of osmoles (Osm) of solute per litre (L) of solution (osmol/L or Osm/L). The osmolarity of a solution is usually expressed as Osm/L ...
*
Urine osmolality Urine osmolality is a measure of urine concentration, in which large values indicate concentrated urine and small values indicate diluted urine. Consumption of water (including water contained in food) affects the osmolality of urine. Osmolality ...

Serum Osmolarity vs. Osmolality


References

{{Blood tests Blood tests