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To the Editor.
—In a paper entitled "Utilization of Osmometry in Critically Ill Surgical Patients" (Arch Surg 102:363, 1971) Boyd et al reported that the measured serum osmolality in critically ill surgical patients tends to be up to about 100 mOsm/liter higher than the value calculated from measured serum sodium, blood urea nitrogen (BUN), and glucose according to the following formula:The difference between the measured serum osmolality and the calculated Sosm is called mOsm-D. The authors point out that "The correlation of the Sosm and the mOsm-D with lactate has been shown to be good (r = 0.793) in late stages of traumatic shock." Furthermore, "Some of the osmolal elevation (25 to 50 mOsm/kg) is probably due to lactic acid accumulating during hemorrhagic hypotension."In the opinion of the undersigned, the accumulation of lactic acid during shock influences neither the
Børresen HC. Utilization of Osmometry in Critically III Surgical Patients. Arch Surg. 1972;105(5):802-803. doi:10.1001/archsurg.1972.04180110119033