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TRANSLATIONAL PHYSIOLOGY

A new formula for predicting alterations in plasma sodium concentration in peritoneal dialysis

Division of Nephrology, David Geffen School of Medicine at UCLA, Los Angeles, California

Submitted 10 October 2004 ; accepted in final form 21 December 2004

Alterations in the plasma water sodium concentration ([Na⁺]_pw) result from changes in the total exchangeable sodium (Na_e), total exchangeable potassium (K_e), and total body water (TBW). The empirical relationship between the [Na⁺]_pw and Na_e, K_e, and TBW was originally demonstrated (Edelman IS, Leibman J, O'Meara MP, and Birkenfeld LW. J Clin Invest 37: 1236–1256, 1958), where [Na⁺]_pw = 1.11(Na_e + K_e)/TBW – 25.6 (Eq. 1). Based on Eq. 1, alterations in the [Na⁺]_pw can be predicted by considering changes in the mass balance of Na⁺, K⁺, and H₂O. In accounting for the mass balance of Na⁺, K⁺, and H₂O in patients on peritoneal dialysis, considerations must also be taken to determine the modulating effect of dialysate clearance of Na⁺ and K⁺ and fluid changes resulting from this therapeutic modality on the [Na⁺]_pw. In this article, we derive a new formula for predicting alterations in the plasma Na⁺ concentration ([Na⁺]_p) in patients on peritoneal dialysis, taking into consideration the empirical relationship between the [Na⁺]_pw and Na_e, K_e, and TBW (Eq. 1) as well as changes in mass balance of Na⁺ + K⁺ and H₂O.

potassium