Method-dependent differences in apparent sodium concentrations in plasma after exchange transfusions with citrated...

Shortly after exchange transfusions (n = 7) with citrate-dextrose-phosphate (CDP)-treated blood, but not after regular transfusions (n = 9), sodium concentrations in plasma were significantly and paradoxically lower (3-10 mmol/L) by Ektachem 700 XR determination [with use of electrolyte reference fluid (ERF) generation 00] than by flame photometry. Similar between-method differences could also be generated by in vitro supplementation of plasma pools with CDP solution, with trisodium citrate, or to a lesser extent with Na2HPO4. For four potentiometric methods the analytical recovery of sodium added as CDP was significantly lower than by flame photometry. Within each potentiometric method the recovery was also less than the value for sodium added as NaCl. A significant association of sodium ions with citrate3- ions and, to a lesser extent, HPO4(2-) ions could theoretically account for at least part of the observations, conferring greater medical relevance to potentiometric measurements in this particular clinical situation.