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Emergency Medicine

The speed and simplicity of testing with a modern Advanced Instruments osmometer makes it a very useful first step in the evaluation of cases presented in the emergency room to monitor the response to fluid therapy and recovery from surgical procedures. Freezing point is the method of choice for osmometers in this field because they are sensitive to all types of solutes. Vapor pressure osmometers will not read volatile solutes, which may deprive the clinician of significant information in cases of toxic ingestion of methanol or ethylene glycol, as well as the necessary ability to monitor therapeutic infusions of mannitol.

· Alcohol Intoxication: The ingestion of toxic substances, often as a cheap alternative to ethanol, is a frequent occurrence and not limited to inner city hospitals. Ethanol ingestion will elevate serum osmolality by 23 mOsm for each 100mg/dl (0.1%.) Measured ethanol in combination with measured osmolality can confirm whether or not intoxication is due to ethanol. 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/Shock: When normal CNS and renal homeostatic mechanisms are unresponsive, serum and urine osmolality can provide rapid determination of appropriate IV Therapy. In the use of mannitol for treatment of brain swelling, osmolality guides appropriate usage of the drug.

· 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.

· Diabetic Coma: Advanced Osmometers yield accurate results in the presence or absence of volatiles. Hence, the serum osmolality in ketoic and non-ketoic patients can be measured with confidence.

· Burns: Osmolality offers a rapid assessment of a burn patient’s state of hydration and helps to monitor proper fluid therapy.

· Drug Intoxication Screening: Probing the osmolal gap, one might find a variety of small MW solutes, at toxic levels, which are most easily detected by an osmometer. Methanol, ethylene glycol, and acetylsalicylic acid (aspirin) are the usual suspects in an emergency room setting.