Osmolality is a measure of the number of dissolved solute particles in solution. It is determined by the number and not by the nature of the particles in solution. Dissolved solutes change the physical properties of solutions, increasing the osmotic pressure and boiling point and decreasing the vapor pressure and freezing point.
The osmolality of serum increases with dehydration and decreases with overhydration. The patient receiving intravenous fluids should have a normal osmolality. If the osmolality rises, the fluids contain relatively more electrolytes than water. If the osmolality falls, relatively more water than electrolytes is being administered.
Normally, the ratio of serum sodium, in mEq/L, to serum osmolality, in mOsm/kg, is between 0.43 and 0.5. The ratio may be distorted in drug intoxication.
Generally, the same conditions that decrease or increase the serum sodium concentration affect the osmolality.
An increased gap between measured and calculated osmolality may indicate ingestion of poison, ethylene glycol, methanol, or isopropanol.