Direct and indirect ion selective electrodes methods: the differences specified through a case of Waldenstrom's macroglobulinemia

Direct and indirect ion selective electrodes (ISEs) are two methods commonly used in biochemistry laboratories in order to measure the electrolytes such as sodium. In the clinical practice, it's the sodium concentration in plasma water -measured by direct ISE-which is important to consider as it is responsible of water movements between the liquid compartments. Knowing the difference between the two methods is important because there are situations leading to conflicting results between direct and indirect ISE, especially with sodium and inappropriate therapeutic decisions could be taken if the clinician is not aware of this difference. The increase and the decrease in plasma water volume are the situations that distort the results of the indirect ISE because this method, after a dilution step, does not take into account the real percentage of plasma water of the patient in the determination of the concentrations (leading for sodium to pseudohyponatremia, pseudonormonatremia or pseudohypernatremia). In the direct ISE, the sample is not diluted and the results are correct even if the volume of plasma water is modified. This article specifies the differences between the two techniques through a case of Waldenstrom's macroglobulinemia and proposes a course of action to follow for both of the biologist and the clinician.