Hyperglycemia causes pseudohyponatremia. The sodium is diluted by the osmotic movement of water from the intracellular to the extracellular compartment. I was taught the Katz conversion to correct the sodium, the sodium falls 1.6 mmol/L for every 100 mg/dL the glucose is over 100. This comes from purely theoretical work and was published in a letter the NEJM in 1972.
In the 1999 Hillier et al published empiric data that showed the ratio to be 2.4 rather than 1.6.
This ratio is now has been adopted by Mass General Handbook of Internal Medicine.
When ever I encounter hypernatremia I use both formulas and I consistently found that the Hillier estimated the final sodium. I wanted to do a study where I looked at hyperglycemia in dialysis patients and measured estimated final sodium versus actual final sodium to see which calculation worked better. It is a compelling study cohort because the lack of urine output guards against renal losses, a potential source of error. Well, the study has been done. Tzamaloukas et al, published a nice study of hyperglycemic dialysis patients and found the ratio of change in glucose to change in sodium was 100:1.5, almost exactly the same as Katz’s calculation and consistant with my experience.
Eat it Hillier.
Update, Dr. Rondon, in a comment below and Martijn vd Hoogen on Twitter, believe that I made a mistake calling hyperglycemic hyponatremia, an example of Pseudohyponatremia. There is some precedent for this position but it is not universal. See this editorial by the American Association for Clinical Chemistry, or McGraw Hill Concise Dictionary of Modern Medicine
@kidney_boy is this pseudohyponatremia? I thought this is dilutional hyponatremia, like mannitol. Pseudohyponatriemia is lab test error.
— Martijn vd Hoogen (@MWF_vd_Hoogen) April 14, 2013
The term of pseudohyponatremia is reserved for spuriously low serum sodium values that is the result of displacement of serum water by displacement of protein or lipids. Hyperglycemia actually shifts water from intracellular to extracellular causing a true dilution.
A pediatric study account for changes in volume and sodium found a correction factor of 1.68
http://archpedi.jamanetwork.com/article.aspx?articleid=381886
What are the chances of two ex-Pittsburgh (Helbert & myself) adjacent year fellows commenting on sodium 😀