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Emergency Medicine
Alcohol Intoxication:
Elevated serum osmolality can be an indication
of alcohol ingestion; the rate of increase is approximately 23 mOsm/kg
for each 100 mg/dl of ethanol. Freezing point methodology is preferred
for this application, as vapor pressure or dew point osmometers are insensitive
to volatile solutes.
Drug Intoxication Screening: The ingestion of toxic substances,
often as a cheap alternative to ethanol, is a frequent occurrence and
not limited to inner city hospitals. Differentiation from alcohols, by
enzymatic means, must be confirmed, but in all instances the course of
treatment is most easily monitored by routine osmolality.
Head Injury: Mannitol, an intracranial pressure (ICP) lowering
agent is sometimes dramatically effective in reversing acute brain swelling.
There is evidence that in prolonged dosage, mannitol may pass from the
blood into the brain, where it might cause reverse osmotic shifts that
increase intracranial pressure. Having a freezing point osmometer available
to rapidly assess these osmotic shifts is valuable.
Coma: In cases where patients are non-responsive or demonstrate
erratic behavior, serum osmolality is a valuable tool to assess mental
status state, patient state of hydration and osmolality.
Burns: Osmolality offers a rapid assessment of the burn patient’s state of hydration and helps to monitor proper fluid therapy.
Quality Control: Pharmacy: Hospital admixtures,
pharmaceutical
manufacturers, and nutritional support formulary can use routine osmolalities.
Benefits include monitoring for consistency and proper formulation, minimizing
infusion trauma, and optimizing uptake and reaction kinetics.
Bibliography