At a Glance
Why Get Tested?
Urine and serum osmolality may be measured together to investigate the cause of a low sodium concentration in the blood (hyponatraemia), or a high or low urine output. Serum osmolality may also be measured when ingestion of toxic alcohols such as methanol and ethylene glycol are suspected. Occasionally, stool osmolality is measured to help determine the cause of chronic diarrhoea.
When to Get Tested?
Urine and serum osmolality should be tested when an explanation is sought for either i) a low serum sodium concentration ii) an unusually high urine output or iii) an unusually low urine output.
Serum osmolality should be tested if poisoning with toxic alcohols is suspected.
Stool osmolality may be tested when an explanation for chronic diarrhoea is being sought.
A blood sample taken from a vein in your arm; a urine sample taken at the same time usually helps the doctor to interpret the results
Test Preparation Needed?
None may be required or you may be instructed to fast for 6 hours before the test; you may be requested to collect a sample of the first urine passed in the morning; follow any instructions provided.
Inform your health care provider of all medications you are taking, especially mannitol.
The Test Sample
What is being tested?
Osmolality is a measure of the number of particles dissolved in a kilogram of fluid. Osmolarity is the number of particles in a litre of fluid. In a dilute fluid osmolality and osmolarity values are approximately the same. An osmotically active substance is any substance that increases the osmolality of a fluid.
Measurement of osmolality in serum and urine is used to assess water balance, and whether the body is reacting appropriately to changes in water balance. Water balance in the body is a dynamic process that is regulated by controlling the amount of water excreted in the urine and by regulating the sensation of "thirst."
Osmotic sensors in the body sense and react to changes in the amount of water and particles in the bloodstream (i.e. factors that alter the osmolality). In health, the osmolality of blood is very closely regulated. When blood osmolality increases, for example in dehydration, the hypothalamus secretes the hormone “antidiuretic hormone” (ADH). ADH signals for the kidneys to conserve water, resulting in formation of concentrated urine (which has a high osmolality). This retention of water dilutes the blood causing a decrease in osmolality back to normal levels. If, on the other hand, blood osmolality decreases (for example following a large drink of water) then ADH secretion is suppressed and the kidneys excrete increased amounts of dilute urine. This results in a decrease in the amount of water in the body, and so blood osmolality rises to normal.
Osmolality can be directly measured in the laboratory using an osmometer.
Calculated Serum Osmolality = 2 (sodium + potassium) + glucose + urea
When all values are in mmol/L. Note, there are several variations of this calculation in use.
The calculated and measured osmolality can be compared to determine if there are other particles present (in addition to sodium, potassium, glucose and urea) that contribute to the measured serum osmolality. The difference between measured and calculated (estimated) osmolality is called the "osmotic gap" or "osmolal gap." An increase in the osmotic gap (greater than 10) indicates the presence of other substances such as toxic alcohols, aspirin, or mannitol.
Osmolality of the urine is used as a measure of the kidneys ability to concentrate urine. Urine osmolality is largely due to the presence of urea and creatinine. The more concentrated the urine is, the higher its osmolality.
How is the sample collected for testing?
A blood sample is taken by needle from a vein in the arm. You may be asked to provide a urine sample.
NOTE: If undergoing medical tests makes you or someone you care for anxious, embarrassed, or even difficult to manage, you might consider reading one or more of the following articles: Coping with Test Pain, Discomfort, and Anxiety, Tips on Blood Testing, Tips to Help Children through Their Medical Tests, and Tips to Help the Elderly through Their Medical Tests.
Another article, Follow That Sample, provides a glimpse at the collection and processing of a blood sample and throat culture.
Is any test preparation needed to ensure the quality of the sample?
No test preparation may be needed or you may be instructed to fast (nothing to eat or drink except water) for 6 hours before the test. Follow any instructions you are given. Because some medications can interfere with this testing, inform your health care provider of all of the medications you are taking, especially if you are taking mannitol.
Ask a Laboratory Scientist
NOTE: This article is based on research that utilizes the sources cited here as well as the collective experience of the Lab Tests Online Editorial Review Board. This article is periodically reviewed by the Editorial Board and may be updated as a result of the review. Any new sources cited will be added to the list and distinguished from the original sources used.