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30 Int J Med Biochem severity of exposure. Several studies have been performed calculating serum ethanol concentrations using various formulas and the osmolal gap as a practical approach when it would take time for the measurement of toxic alcohol or when these substances cannot be measured [5, 6]. Nowadays, ethanol is an easily obtainable substance, and therefore, in this study, the aim was to calculate the osmolal gap using 6 osmolarity formulas published in the literature and compare the measured ethanol concentrations with estimated ethanol concentrations obtained from various ethanol calculation formulas that include the osmolal gap. Materials and Methods This research was designed as a prospective study. The study included 257 individuals (44 females, 213 males) who were admitted to the Ankara Numune Training and Research Hospital emergency department with a serum ethanol concentration between 2.60 and 80.31 mmol/L (12 mg/dL and 370 mg/dL). Lipemic, hemolyzed samples and diabetic, hypernatremic, hyperproteinemic, or mannitol-treated patients were excluded. Between-day imprecisions (coefficient of variation [CV] %), mean, and standard deviation (SD) of ethanol, sodium, potassium, glucose, and urea parameters were determined using internal quality control materials. These parameters were measured using a Beckman Coulter AU680 autoanalyser (Beckman Coulter, Inc., Brea, CA, USA) and 6 different osmolarity formulas were used to calculate osmolarity values (Table 1). In the vast majority of publications, these formulas are used to calculate serum osmolality, but in fact, these are formulas of serum osmolarity, because the unit used is mOsmol/L. For that reason, in this study, a correction coefficient of 0.995 was used to convert osmolarity to osmolality [7, 8]. There was no available quality control material for the osmometer, so we used 2 levels of serum pool created from patients’ and normal individuals' sera. During the study period, between-day variations were evaluated using the samples obtained from the serum pool and mean, SD, and CV% values were calculated. For calibration, deionized water (0 mOsmol/ kg H2O) and a calibration solution (400 mOsmol/kg H2O) supplied by the manufacturer were used. Serum osmolality was measured with the osmometer (Knauer Wissenschaftliche Geräte GmbH, Berlin, Germany) using the freezing-point depression method. For each sample, 6 different osmolal gap values were determined using calculated and measured osmolality values. These osmolal gap values were used in the 4 formulas provided in Table 2, and the results were Table 1. Osmolarity formulas used in the study Formula No Osmolarity Formulasa References (OSMC-1) Osm=2 Na+(Glu/18)+(BUN/2.8) (15) (OSMC-2) Osm=1.86 (Na+K)" + " 1.15(Glu/18)+(BUN/2.8)+14 (16) (OSMC-3) Osm=1.86 Na+1,38 K+1.08(Glu/18)+1.03(BUN/2.8)+7.45 (18) (OSMC-4) Osm=1.897 Na+(Glu/18)+(BUN/2.8)+13.5 (19) (OSMC-5) Osm=1.09[1.86Na+(Glu/18)+(BUN/2.8)] (20) (OSMC-6) Osm=1.86 Na+(Glu/18)+(BUN/2.8)+9 (17) To convert osmolarity (mOsmol/L) to osmolality (mOsmol/kg), a coefficient of 0.995 (0.926/0.93) was used (0.926 is the osmotic coefficient for sodium, which is the most effective osmolite in serum, and 0.93 is the water content of serum). a: Na and K: mmoI/L; Glu and BUN: mg/dL. BUN: Blood urea nitrogen; GLU: Glucose; K: Potassium; Na: Sodium; Osm: Osmolarity. Table 2. Formulas used to estimate ethanol concentration

Comparison of measured ethanol and calculated ethanol using osmolal gap and osmolarity formulas