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SOLUTE HYPERTONICITY

Divisi PGD PICU


Departemen Ilmu Kesehatan Anak
FK USU RS. H. Adam Malik
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Osmosis: the diffusion of solvent molecules into a region in which there
is a higher concentration of a solute to which the membrane is
impermeable
Osmotic pressure: the pressure necessary to prevent solvent migration
Osmoles: the concentration of osmotically active particle
Osmolarity: the number of osmoles per liter of solution (eg, plasma)
Osmolality: the number of osmoles per kilogram of solvent
Osmolality = 2 !"a#$ !glucose#%l& $ !'("#%2)&
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(rea is not confined to the e*tracellular space because it readily crosses
the cell membrane and its intracellular concentration appro*imately e+uals
its e*tracellular concentration
,ith uremia, there is no osmolar gradient between the 2 compartments and
conse+uently, no movement of water
-he only e*ception is during hemodialysis, when the decrease in
e*tracellular urea is so rapid that the intracellular urea does not have time
to e+uilibrate
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"ormally, the measured osmolality and the calculated osmolality are
within ./ mOsm%kg
-he presence of 0unmeasured osmoles0 causes the measured osmolality
to be significantly elevated when compared with the calculated osmolality
the osmolal gap
1*amples of unmeasured osmoles include ethanol, ethylene, glycol,
methanol, and mannitol
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-onicity:
-he effective osmolality
(sed to describe the osmolality of a solution relative to
plasma isotonic, hypertonic, hypotonic
-he effective osmolality determines the osmotic force that is
mediating the shift of water between the 123 and the 423
1ffective osmolality = 2 !"a# $ !glucose#%l&
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www.uic.edu/classes/bios/bios100/summer2003/hypert.jpg
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HYPERGLYCEMIA
2auses an increase in the plasma osmolality
5uring hyperglycemia there is a shift of water from the intracellular
space to the e*tracellular space clinically important in children with
hyperglycemia during diabetic ketoacidosis
-he shift of water causes dilution of the sodium in the e*tracellular
space, causing hyponatremia despite an elevated plasma osmolality
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-he magnitude of this effect can be calculated as follows:
!"a#corrected = !"a#measured $ . )6 (!glucose# 7 .// mg%d8)%.//
!"a# measured = sodium concentration measured by the clinical
8aboratory
!"a# corrected = corrected sodium concentration (the sodium
concentration if the glucose concentration were
normal and its accompanying water moved back into
the cells)
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Hyperglycemia

!ype 1 #$

!ype 2 #$

%tress&i'duced Hyperglycemia
critically ill
( 180 mg/dl 0)05 & 0)1 u'it/*g++/jam ,-

!./&i'duced Hyperglycemia

$edicatio'

0actitious Hyperglycemia
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