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NBS SPECIAL PUBLICATION 260-60

U.S. DEPARTMENT OF COMMERCE / National Bureau of Standards

Standard Reference Materials:

A REFERENCE METHOD FOR THE

DETERMINATION OF SODIUM IN SERUM
NATIONAL BUREAU OF STANDARDS

The National Bureau of Standards' was established by an act of Congress March 3, 1901 . The

Bureau's overall goal is to strengthen and advance the Nation's science and technology and

facilitate their effective application for public benefit. To this end, the Bureau conducts

research and provides: (1) a basis for the Nation's physical measurement system, (2) scientific and technological services for industry and government, (3) a technical basis for equity in trade, and (4) technical services to promote public safety. The Bureau's technical work is performed by the National Measurement Laboratory, the National Engineering Laboratory,

and the Institute for Computer Sciences and Technology.

THE NATIONAL MEASUREMENT LABORATORY provides the national system of

physical and chemical and materials measurement; coordinates the system with measurement

systems of other nations and furnishes essential services leading to accurate and uniform

physical and chemical measurement throughout the Nation's scientific community, industry,

and commerce; conducts materials research leading to improved methods of measurement,

standards, and data on the properties of materials needed by industry, commerce, educational

institutions, and Government; provides advisory and research services to other Government

Agencies; develops, produces, and distributes Standard Reference Materials; and provides

calibration services. The Laboratory consists of the following centers:

Absolute Physical Quantities-' — Radiation Research — Thermodynamics and

Molecular Science — Analytical Chemistry — Materials Science.

THE NATIONAL ENGINEERING LABORATORY provides technology and technical

services to users in the public and private sectors to address national needs and to solve

national problems in the public interest; conducts research in engineering and applied science

» in support of objectives in these efforts; builds and maintains competence in the necessary

disciplines required to carry out this research and technical service; develops engineering data

and measurement capabilities; provides engineering measurement traceability services; develops test methods and proposes engineering standards and code changes; develops and

proposes new engineering practices; and develops and improves mechanisms to transfer

results of its research to the utlimate user. The Laboratory consists of the following centers:

Applied Mathematics — Electronics and Electrical Engineering2 — Mechanical

Engineering and Process Technology 2 — Building Technology — Fire Research —

Consumer Product Technology — Field Methods.

THE INSTITUTE FOR COMPUTER SCIENCES AND TECHNOLOGY conducts

research and provides scientific and technical services to aid Federal Agencies in the selection,

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provides the technical foundation for computer-related policies of the Federal Government.

The Institute consists of the following divisions:

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'Headquarters and Laboratories at Gaithersburg, Maryland, unless otherwise noted; mailing address Washington, D.C. 20234.

: Some divisions within the center are located at Boulder, Colorado, 80303.

The National Bureau of Standards was reorganized, effective April 9, 1978.
Natloni) Bureau of Standards

OCT 13

Standard Reference Materials:

A REFERENCE METHOD FOR THE DETERMINATION fD

; ;iw,' fco

OF SODIUM IN SERUM

^

Ranee A. Velapoldi, Robert C. Paule, ' f^, 2. 6jG~U o

Robert Schaffer, John Mandel,

and John R. Moody

National Measurement Laboratory

National Bureau of Standards

Washington, D. C. 20234

With the cooperation of a Committee of Experts:

George N. Bowers, Jr., 1 Bradley E. Copeland,2 Denis O. Rodgerson,3 and James C. White4

'Hartford Hospital, Hartford, Connecticut

2 New England Deaconess Hospital, Boston, Massachusetts

3 Department of Pathology, University of California,

Los Angeles, California

4 Center for Disease Control, Atlanta, Georgia

U.S. DEPARTMENT OF COMMERCE, Juanita M. Kreps, Secretary

Dr. Sidney Harman, Under Secretary

Jordan J. Baruch, Assistant Secretary for Science and Technology

'NATIONAL BUREAU OF STANDARDS, Ernest Ambler, Director

Issued August 1978
Library of Congress Cataloging in Publication Data

Main entry under title: A Reference method for the determination of sodium in serum. (NBS Special publication ; 260-60)

"SD catalog no. CI 3. 10:260-60."

1. Serum—Analysis—Standards. 2. Sodium—Analysis—Standards. 3. Sodium—Spectra. 4. Flame spectroscopy. I. Velapoldi, R.A.

II. National Measurement Laboratory. III. United States. National Bureau of Standards. IV. Series: United States. National Bureau of Standards. Special publication ; 260-60. QC 1 00. U57 no. 260-60 [ RB46] 602. 1 s [6 1 6.07'56 1 ] 78-606 1 06

National Bureau of Standards Special Publication 260-60

Nat. Bur. Stand. (U.S.), Spec, Publ. 260-60, 106 pages (Aug. 1978)

CODEN: XNBSAV

DISCLAIMER

Identification of commercial products does not

imply recommendation or endorsement by the

National Bureau of Standards nor that the

product is necessarily the best available for the

purpose.

U.S. GOVERNMENT PRINTING OFFICE

WASHINGTON: 1978

For sale by the Superintendent of Documents, U.S. Government Printing Office, Washington, D.C. 20402

Stock No. 003-003-01978-0 Price $3

(Add 25 percent additional for other than U.S. mailing).
FOREWORD

A fundamental requirement for assuring adequate patient

care is the need for the accurate analysis of constituents in

body fluids. Two major functions of the National Bureau of

Standards (NBS) are to provide certified Standard Reference

Materials for the calibration of measurement systems and to

develop new or improved analytical methods. The results presented in this NBS Special Publication provide a methodology

of known accuracy for the determination of sodium in serum.

The evaluation of a reference method by comparison to a

definitive method, used for the first time at NBS in the

development of a reference method for calcium in serum, also

was applied to this work. This hierarchy of analytical procedures has been accepted as a valid format for developing

reference methods by the clinical community at a recent

Conference on an Understanding for a National Reference

System in Clinical Chemistry.

In an undertaking of this magnitude, extensive collaboration with a committee of experts, the Center for Disease

Control, the Food and Drug Administration, and a wide

spectrum of participating analytical laboratories that

included Federal, state, hospital, industrial, and academic

laboratories was essential to establish a widely accepted

reference method. It is hoped that this work will provide

an additional basis for the development of future clinical

reference methods through continued collaboration and the

concerted efforts of the individual participants.

Philip D. LaFleur, Director

Center for Analytical Chemistry

iii
PREFACE

Standard Reference Materials (SRM's) as defined by the

National Bureau of Standards are "well-characterized materials, produced in quantity, that calibrate a measurement

system to assure compatibility of measurement in the nation."

SRM's are widely used as primary standards in many diverse

fields in science, industry, and technology, both within the

United States and throughout the world. In many industries

traceability of their quality control process to the national

measurement system is carried out through the mechanism and

use of SRM's. For many of the nation's scientists and technologists it is therefore of more than passing interest to

know the details of the measurements made at NBS in arriving

at the certified values of the SRM's produced. An NBS series

of papers, of which this publication is a member, called the

NBS Special Publication - 260 Series is reserved for this

purpose

.

This 260 Series is dedicated to the dissemination of

information on all phases of the preparation, measurement,

and certification of NBS-SRM's. In general, much more detail will be found in these papers than is generally allowed,

or desirable, in scientific journal articles. This enables

the user to assess the validity and accuracy of the measurement processes employed, to judge the statistical analysis,

and to learn details of techniques and methods utilized for

work entailing the greatest care and accuracy. It is also

hoped that these papers will provide sufficient additional

information not found on the certificate so that new applications in diverse fields not foreseen at the time the SRM

was originally issued will be sought and found.

Inquiries concerning the technical content of this

paper should be directed to the author(s). Other questions

concerned with the availability, delivery, price, and so

forth will receive prompt attention from:

Office of Standard Reference Materials

National Bureau of Standards

Washington, D.C. 20234

J. Paul Cali, Chief

Office of Standard Reference Materials

i v
OTHER NBS PUBLICATIONS IN THIS SERIES

Catalog of NBS Standard Reference Materials

(1975-76 edition), R. W. Seward, ed., NBS

Spec. Publ. 260 (June 1975). $1.50* SN003-003-

01445-1

Michaelis, R. E., and Wyman, L. L., Standard

Reference Materials: Preparation of White Cast

Iron Spectrochemical Standards, NBS Misc.

Publ. 260-1 (June 1964). COM74-1 1061**

Michaelis, R. E., Wyman, L. L., and Flitsch, R.,

Standard Reference Materials: Preparation of

NBS Copper-Base Spectrochemical Standards,

NBS Misc. Publ. 260-2 (October 1964). COM74-

11063**

Michaelis, R. E., Yakowitz, H., and Moore, G. A.,

Standard Reference Materials: Metallographic

Characterization of an NBS Spectrometric LowAlloy Steel Standard, NBS Misc. Publ. 260-3

(October 1964). COM74-1 1060**

Hague, J. L., Mears, T. W., and Michaelis, R. E.,

Standard Reference Materials: Sources of

Information, NBS Misc. Publ. 260-4 (February

1965). COM74-11059

Alvarez, R., and Flitsch, R., Standard Reference

Materials: Accuracy of Solution X-Ray Spectrometric Analysis of Copper-Base Alloys, NBS

Misc. Publ. 260-5 (March 1965). PB168068**

Shultz, J. I., Standard Reference Materials:

Methods for the Chemical Analysis of White

Cast Iron Standards, NBS Misc. Publ. 260-6

(July 1975). COM74-1 1068**

Bell, R. K., Standard Reference Materials:

Methods for the Chemical Analysis of NBS

Copper-Base Spectrochemical Standards, NBS

Misc. Publ. 260-7 (October 1965). COM74-

11067**

Richmond, M. S., Standard Reference Materials:

Analysis of Uranium Concentrates at the

National Bureau of Standards, NBS Misc. Publ.

260-8 (December 1965). COM74-1 1066**

Anspach, S. C, Cavallo, L. M., Garfinkel, S. B.,

Hutchinson, J. M. R., and Smith, C. N., Standard Reference Materials: Half Lives of Materials

Used in the Preparation of Standard Reference

Materials of Nineteen Radioactive Nuclides

Issued by the National Bureau of Standards,

NBS Misc. Publ. 260-9 (November 1965).

COM74-11065**

Yakowitz, H., Vieth, D. L., Heinrich, K. F. J., and

Michaelis, R. E., Standard Reference Materials:

Homogeneity Characterization on NBS Spectrometric Standards II: Cartridge Brass and LowAlloy Steel, NBS Misc. Publ. 260-10 (December

1965). COM74-11064**

Napolitano, A., and Hawkins, E. G., Standard

Reference Materials: Viscosity of Standard

Lead-Silica Glass, NBS Misc. Publ. 260-11

(November 1966). NBS Misc. Publ. 260-11**

Yakowitz, H., Vieth, D. L., and Michaelis, R. E.,

Standard Reference Materials: Homogeneity

Characterization of NBS Spectrometric Standards III: White Cast Iron and Stainless Steel

Powder Compact, NBS Misc. Publ. 260-12

(September 1966). NBS Misc. Publ. 260-12**

Spijkerman, J. I., Snediker, D. K., Ruegg, F. C,

and DeVoe, J. R., Standard Reference Materials: Mossbauer Spectroscopy Standard for the

Chemical Shift of Iron Compounds, NBS Misc.

Publ. 260-13 (July 1967). NBS Misc. Publ.

260-13**

Menis, O., and Sterling, J. T., Standard Reference

Materials: Determination of Oxygen in Ferrous

Materials - SRM 1090, 1091, and 1092, NBS

Misc. Publ. 260-14 (September 1966). NBS Misc.

Publ. 260-14**

Passaglia, E., and Shouse, P. J., Standard Refer- ence Materials: Recommended Method of Use

of Standard Light-Sensitive Paper for Calibrating Carbon Arcs Used in Testing Textiles for

Colorfastness to Light, NBS Misc. Publ. 260-15

(June 1967). (Replaced by NBS Spec. Publ.

260-41.)

Yakowitz, H., Michaelis, R. E., and Vieth, D. L.,

Standard Reference Materials: Homogeneity

Characterization of NBS Spectrometric Standards IV: Preparation and Microprobe Characterization of W-20% MO Alloy Fabricated by

Powder Metallurgical Methods, NBS Spec.

Publ. 260-16 (January 1969). COM74-1 1062**

Catanzaro, E. J., Champion, C. E., Garner, E. L.,

Marinenko, G., Sappenfield, K. M., and Shields,

W. R., Standard Reference Materials: Boric

Acid; Isotopic and Assay Standard Reference

Materials, NBS Spec. Publ. 260-17 (February

1970). Out of Print

v
Geller, S. B., Mantek, P. A., and Cleveland, N.

G., Standard Reference Materials: Calibra

tion of NBS Secondary Standard Magnetic Tape

(Computer Amplitude Reference) Using the

Reference Tape Amplitude Measurement

"Process A," NBS Spec. Publ. 260-18 (November

1969). (See NBS Spec. Publ. 260-29.)

Paule, R. C, and Mandel, J., Standard Reference

Materials: Analysis of Interlaboratory Measurements on the Vapor Pressure of Gold (Certification of Standard Reference Material 745), NBS

Spec. Publ. 260-19 (January 1970). PB190071**

Paule, R. C, and Mandel, J., Standard Reference

Materials: Analysis of Interlaboratory Measurements on the Vapor Pressures of Cadmium and

Silver, NBS Spec. Publ. 260-21 (January 1971).

COM74-11359**

Yakowitz, H., Fiori, C. E., and Michaelis, R. E.,

Standard Reference Materials: Homogeneity

Characterization of Fe-3 Si Alloy, NBS Spec.

Publ. 260-22 (February 1971). COM74-1 1357**

Napolitano, A., and Hawkins, E. G., Standard

Reference Materials: Viscosity of a Standard

Borosilicate Glass, NBS Spec. Publ. 260-23

(December 1970). COM7 1-00 157**

Sappenfield, K. M., Marineko, G., and Hague, J.

L., Standard Reference Materials: Comparison

of Redox Standards, NBS Spec. Publ. 260-24

(January 1972). COM 72-50058**

Hicho, G. E., Yakowitz, H., Rasberry, S. D., and

Michaelis, R. E., Standard Reference Materials:

A Standard Reference Material Containing

Nominally Four Percent Austenite, NBS Spec.

Publ. 260-25 (February 1971). COM 74-1 1356**

Martin, J. F., Standard Reference Materials:

National Bureau of Standards-US Steel Corportion Joint Program for Determining Oxygen and

Nitrogen in Steel, NBS Spec. Publ. 260-26

(February 1971). 85 cents* SN003-003-00786-2

Garner, E. L., Machlan, L. A., and Shields, W. R.,

Standard Reference Materials: Uranium

Isotopic Standard Reference Materials, NBS

Spec. Publ. 260-27 (April 1971). COM74-

11358**

Heinrich, K. F. J., Myklebust, R. L., Rasberry, S. D., and Michaelis, R. E., Standard Reference

Materials: Preparation and Evaluation of

SRM's 481 and 482 Gold-Silver and GoldCopper Alloys for Microanalysis, NBS Spec.

Publ. 260-28 (August 1971). COM7 1-50365**

Geller, S. B., Standard Reference Materials: Calibration of NBS Secondary Standard Magnetic

Tape (Computer Amplitude Reference) Using

the Reference Tape Amplitude Measurement

"Process A-Model 2," NBS Spec. Publ. 260-29

(June 1971). COM71-50282**

Gorozhanina, R. S., Freedman, A. Y., and

Shaievitch, A. B. (translated by M. C. Selby),

Standard Reference Materials: Standard

Samples Issued in the USSR (A Translation

from the Russian), NBS Spec. Publ. 260-30 (June

1971). COM71-50283**

Hust, J. G., and Sparks, L. L., Standard Reference

Materials: Thermal Conductivity of Electrolytic

Iron SRM 734 from 4 to 300 K, NBS Spec. Publ.

260-31 (November 1971). COM7 1-50563**

Mavrodineanu, R., and Lazar, J. W., Standard

Reference Materials: Standard Quartz Cuvettes,

for High Accuracy Spectrophotometry, NBS

Spec. Publ. 260-32 (December 1973). 55 cents*

SN003-003-01213-1

Wagner, H. L., Standard Reference Materials:

Comparison of Original and Supplemental

SRM 705, Narrow Molecular Weight Distribution Polystyrene, NBS Spec. Publ. 260-33

(May 1972). COM72-50526**

Sparks, L. L., and Hust, J. G., Standard Reference

Materials: Thermoelectric Voltage, NBS Spec.

Publ. 260-34, (April 1972). COM72-50371**

Sparks, L. L., and Hust, J. G., Standard Refer- ence Materials: Thermal Conductivity of

Austenitic Stainless Steel, SRM 735 from 5 to 280 K, NBS Spec. Publ. 260-35 (April 1972.)

35 cents* COM72-50368**

Cali, J. P., Mandel, J., Moore, L. J., and Young, D.

S., Standard Reference Materials: A Referee

Method for the Determination of Calcium in Serum, NBS SRM 915, NBS Spec. Publ. 260-36

(May 1972). COM72-50527**

Shultz, J. I., Bell, R. K., Rains, T. C, and Menis,

O., Standard Reference Materials: Methods of

Analysis of NBS Clay Standards, NBS Spec.

Publ. 260-37 (June 1972). COM72-50692**

Richmond, J. C, and Hsia, J. J., Standard Refer- ence Materials: Preparation and Calibration of

Standards of Spectral Specular Reflectance,

NBS Spec. Publ. 260-38 (May 1972). COM72- \

50528**

Clark, A. F., Denson, V. A., Hust, J. G., and

Powell, R. L., Standard Reference Materials:

The Eddy Current Decay Method for Resistivity 1

Characterization of High-Purity Metals, NBS

Spec. Publ. 260-39 (May 1972). COM72-50529** ;
McAdie, H. G., Gam, P. D., and Menis, O., Standard Reference Materials: Selection of Thermal

Analysis Temperature Standards Through a Cooperative Study (SRM 758, 759, 760), NBS

Spec. Publ. 260-40 (August 1972.) COM-72

50776**

Wood, L. A., and Shouse, P. J., Standard

Reference Materials: Use of Standard LightSinsitive Paper for Calibrating Carbon Arcs

Used in Testing Textiles for Colorfastness to

Light, NBS Spec. Publ. 260-41 (August 1972)

COM72-50775**

Wagner, H. L., and Verdier, P. H., eds., Standard

Reference Materials: The Characterization of

Linear Polyethylene, SRM 1475, NBS Spec.

Publ. 260-42 (September 1972). COM72-

50944**

Yakowitz, H., Ruff, A. W., and Michaelis, R. E.,

Standard Reference Materials: Preparation and

Homogeneity Characterization of an Austenitic

Iron-Chromium-Nickel Alloy, NBS Spec. Publ.

260-43 (November 1972). COM73-50760**

Schooley, J. F., Soulen, R. J., Jr., and Evans, G. A.,

Jr., Standard Reference Materials: Preparation

and Use of Superconductive Fixed Point

Devices, SRM 767, NBS Spec. Publ. 260-44

(December 1972). COM73-50037**

Greifer, B., Maienthal, E. J., Rains, T. C, and

Rasberry, S. D., Standard Reference Materials:

Powdered Lead-Based Paint, SRM 1579, NBS

Spec. Publ. 260-45 (March 1973). COM73-

: 50226**

j Hust, J. G., and Giarratano, P. J., Standard Refer- ence Materials: Thermal Conductivity and

' Electrical Resistivity Standard Reference Materials: Austenitic Stainless Steel, SRM's 735 and

i 798, from 4 to 1200 K, NBS Spec. Publ. 260^6

i (March 1975). SN003-003-0 1278-5

; Hust, J. G., Standard Reference Materials: Electrical Resistivity of Electrolytic Iron, SRM 797,

and Austenitic Stainless Steel, SRM 798, from 5

to 280 K, NBS Spec. Publ. 260^17 (February

I 1974). COM74-50176**

; Mangum, B. W., and Wise, J. A., Standard Refer- ence Materials: Description and Use of Precision

i Thermometers for the Clinical Laboratory,

SRM 933 and SRM 934, NBS Spec. Publ. 260-48

(May 1974). 60 cents* SN003-003-0 1278-5

Carpenter, B. S., and Reimer, G. M., Standard

Reference Materials: Calibrated Glass Standards for Fission Track Use, NBS Spec. Publ.

260-49 (November 1974). SN003-003-0 1344-7

Hust, J. G., and Giarratano, P. J., Standard Refer- ence Materials: Thermal Conductivity and Electrical Resistivity Standard Reference Materials:

Electrolytic Iron, SRM's 734 and 797 from 4 to

1000 K, NBS Spec. Publ. 260-50 (June 1975).

1.00* SN003-003-0 1425-7

Mavrodineanu, R., and Baldwin, J. R., Standard

Reference Materials: Glass Filters Asa Standard

Reference Material for Spectrophotometry;

Selection; Preparation; Certification; Use -SRM

930, NBS Spec. Publ. 260-51 (November 1975).

$1.90* SN003-003-01481-8

Hust, J. G., and Giarratano, P. J., Standard Refer- ence Materials: Thermal Conductivity and Electrical Resistivity Standard Reference Materials

730 and 799, from 4 to 3000 K, NBS Spec. Publ.

260-52 (September 1975). $1.05* SN003-003-

01464-8

Durst, R. A., Standard Reference Materials:

Standardization of pH Measurements, NBS

Spec. Publ. 260-53 (December 1975, Revised).

$1.05* SN003-003-01551-2

Burke, R. W., and Mavrodineanu, R., Standard

Reference Materials: Certification and Use of

Acidic Potassium Dichromate Solutions as an

Ultraviolet Absorbance Standard, NBS Spec.

Publ. 260-54 (August 1977). $3.00* SN003-003-

01828-7

Ditmars, D. A., Cezairliyan, A., Ishihara, S., and

Douglas, T. B., Standard Reference Materials:

Enthalpy and Heat Capacity; Molybdenum

SRM 781, From 273 to 2800 K, NBS Spec. Publ.

260-55 (September 1977). $2.20* SN003003-

01836-8

Powell, R. L., Sparks, L. L., and Hust, J. G.,

Standard Reference Materials: Standard

Thermocouple Material, Pt.-67:SRM1967, NBS

Spec. Publ. 260-56 (February 1978). $2.20*

SN003-O03-0 18864

Cali, J. P. and Plebanski, T., Guide to United

States Reference Materials, NBS Spec. Publ.

260-57 (February 1978). $2.20* SN003-003-

01883-0

Barnes, J. D. and Martin, G. M., Standard Refer- ence Materials: Polyester Film for Oxygen Gas

Transmission Measurements. SRM 1470, NBS

Spec. Publ. 260-58 (in press).

Chang, T. and Kahn, A. H., Standard Reference

Materials: Electron Paramagnetic Resonance

Intensity Standard: SRM 2601, NBS Spec.

Publ. 260-59 (in press).

vii
Velapoldi, R. A., Paule, R. C, Schaffer, R.,

Mandel, Jr., and moody, J. R., Standard Refer- ence Materials: A Reference Method for the

Determination of Sodium in Serum, NBS Spec.

Publ. 260-60 (in press).

* Send order with remittance to: Superintendent

of Documents, US Government Printing

Office, Washington, DC 20402. Remittance

from foreign countries should include an

additional one-fourth of the purchase price for

postage.

** May be ordered from: National Technical

Information Services (NTIS), Springfield,

Virginia 22151.
TABLE OF CONTENTS

PAGE

I. INTRODUCTION

.

2

II. DEVELOPMENT OF THE SERUM SODIUM REFERENCE METHOD. 4

A. Organization . 4

B. Participating Laboratories, Standards, Serum

Samples, and Definitive Method . 6

C. Functions of the Various Groups 9

D. Plan for Testing the Candidate Reference

Method. . . v 11

III. REFERENCE METHOD PROTOCOL FOR THE DETERMINATION

OF SERUM SODIUM 12

A. General 12

B. Protocol Synopsis 12

C. Detailed Protocol 14

IV. RESULTS AND STATISTICAL ANALYSIS 30

A. Round Robin Results 31

V. DISCUSSION 61

A. Candidate Protocol 61

VI. CONCLUSIONS 65

pi. REFERENCES 67

APPENDIX A 69

APPENDIX B 70

APPENDIX C 72

APPENDIX D 86

ix
LIST OF TABLES

TABLE NO . PAGE

1. Preliminary results from NBS and CDC for the

determination of serum sodium 5

2. Sodium concentrations for the seven serum pools

as determined by ion-exchange-gravimetry (IEG,

the definitive method) , and neutron activation

analysis (NAA) 9

3. Sodium chloride standard solutions 17

4. Example of intensity values for sets of readings

using a direct read-out instrument 28

5. Serum sodium concentrations reported by the

participating laboratories for the Preliminary

Round Robin, manual pipetting protocol 32

6. Concentrations of serum sodium reported by the

participating laboratories for Round Robin I,

manual pipetting protocol 35

7. Concentrations of serum sodium reported by the 39

participating laboratories for Round Robin II, §

manual pipetting protocol 40

8. Concentrations of serum sodium reported by the 41

participating laboratories for Round Robin II, §

semiautomated pipetting protocol 42

9. Percent deviations from averages for sodium in

serum from Round Robin II, manual pipetting

protocol 45

10. Percent deviations from averages for sodium in

serum from Round Robin II, semiautomated

pipetting protocol 46

11. Ratios of standard deviations to average standard

deviations for sodium in serum from Round Robin

II, manual pipetting protocol 48

12. Ratios of standard deviations to average standard

deviations for sodium in serum from Round Robin

II, semiautomated pipetting protocol 49

13. Components of standard deviation in mmol/L for

sodium in serum, Round Robin II 52

x
LIST OF TABLES (continued)

TABLE NO . PAGE

14. Summary of imprecision and bias results in mmol/L

for sodium in serum, Round Robin II 54

15. Summary of sodium in serum values ±2 standard

errors. ...... 56

16. Calibration curve data for sodium in serum,

Round Robin II using manual pipetting 58

17. Calibration curve data for sodium in serum,

Round Robin II using semiautomated pipetting. . 59

60

18. Calibration curve results for sodium in serum as

standard deviation of fit ( s £^ t

) i- n mmol/L. .

19. Instruments and operating conditions used by the

participating laboratories in RRII 63

LIST OF FIGURES

FIGURE NO . PAGE

1. Interrelationships and functions of the various

groups in the development of a clinical

reference method for the determination of

serum sodium 10

2. Typical calibration curve for the determination

of serum sodium by flame atomic emission

spectroscopy 26

3. Percent deviations of individual results from the

collective average of the measurements obtained

in the Preliminary Round Robin test 33

4. Percent deviations of the Round Robin I measurements from the definitive method values .... 36

5. Percent deviations of the Round Robin II measurements using manual pipetting from the

definitive method values 43

6. Percent deviations of the Round Robin II measurements using semiautomated pipetting from the

definitive method values 44

xi

ABSTRACT

Guided by a committee of experts in clinical chemistry,

a reference method was established for the determination of

serum sodium based on flame atomic emission spectroscopy

(FAES) . Its accuracy was evaluated by comparing the values

obtained by use of the method in twelve laboratories against

the results obtained by a definitive analytical method

based on an ion-exchange sodium separation followed by

gravimetry as Na 2 S04 . Seven serum pools with sodium concentrations in the range 1155.2 to 158.6 mmol/L were analyzed.

Manual and semiautomated pipetting alternatives were tested

using sample sizes of 5.0 and 0.25 mL , respectively.

The laboratories used several different FAES instruments.

The results showed that the standard error for a single

laboratory's performance of the procedure ranged from 0.46

to 0.86 mmol/L with a maximum bias of 1.0 mmol/L over the

range of concentrations studied. These values were within

the accuracy and precision goals that had been set by the

committee. There were no significant differences in the

results from the two pipetting techniques. The calibration

curve data showed excellent linearity over the total concentration range, with 21 of 26 curves having standard deviations of fit of 0.5 mmol/L or less.

With appropriate experimental design, the reference

method may be used to establish the accuracy of field methods

as well as to determine reference sodium values for pooled

sera

Key Words: Clinical analysis; clinical chemistry; definitive

method; electrolytes; flame atomic emission spectroscopy;

reference method; semiautomated pipetting; serum sodium

analys is .

1
I. INTRODUCTION

Serum sodium can be determined by a wide variety of

analytical methods; these include (1) separation by precipitation with measurement by photometry, gravimetry, or titrimetry, (2) separation by ion-exchange with measurement by

photometry, and (3) direct analysis by use of ion- select ive

electrodes, neutron activation, or flame atomic emission

1 2

spectroscopy (FAES) [1] . The use of flame atomic emission

spectroscopy has been described as a standard method [2]

.

Whether the latter method or some other should be considered

by clinical laboratories as the clinical reference method

for serum sodium has not been proven; the accuracy of none

of these methods is known.

Two approaches may be used for establishing the accuracy

of analytical methods. In the first, the results obtained

from the methods in use for that analyte are compared using

typical samples and selected samples containing known interferences for the analyses. Statistical correlations are

used to express T.he interrelationships of the methods. A

technique is then considered to be accurate to the degree

established by knowledge of the sources of error and the

agreement of results. In the second, a single candidate

method is selected (possibly the 'best' of the methods

recognized by the first approach) and studied in detail.

Each step of the candidate method is optimized and examined

so that the systematic and the random errors can be quantitatively expressed.

Official name, International Union of Pure and Applied

Chemistry, Information Bulletin Number 27, Nov. 1972.

The bracketed numerals refer to the references listed at

the end of this paper.

2
Cali et al. [3] organized a study using a combination

of these approaches to establish the accuracy of a clinical

chemistry method for total calcium in serum, based on the

flame atomic absorption spectrometr ic (FAAS) method of

Pybus , Feldman, and Bowers [4] . The accuracy of the FAAS

method was assessed by comparing the results obtained using

it on several human serum pools in selected clinical laboratories against those obtained for the same pools by an

isotope dilution-mass spectrometry method (IDMS) . The IDMS

method was performed at the National Bureau of Standards

(NBS) where the high accuracy of that method was established

by the second approach of determining its systematic and

random errors [5].

The Cali et al. study, carried out with the guidance of

clinical laboratory experts, used (a) Standard Reference

Material Calcium Carbonate (SRM 915) 99.9+ percent pure as the

pure primary reference material to prepare standard solutions

for all the analyses; (b) serum pools prepared at the Hartford

Hospital (Hartford) and at the Center for Disease Control

(CDC, Atlanta); (c) pools analyzed for calcium by IDMS at NBS;

(d) statistical analysis of the data at NBS; and (e) accuracy

and precision goals as performance standards that the FAAS

method would have to meet to be considered acceptable as the

clinical reference method for total calcium in serum [6].

This same approach was adopted to develop clinical

reference methods for a number of other serum electrolytes

including sodium potassium, chloride, lithium, and magnesium.

This work was begun with the cooperation of individuals from

the Standards Committees of the American Association for

Clinical Chemistry (AACC) and the College of American Pathologists (CAP), the CDC and the NBS. The Food and Drug

Such a method is referred to as a definitive method because

of its high accuracy and utility for evaluating the accuracy

of a candidate reference method.

3
Administration (FDA) provided major suppport for the NBS

work. We present in this report the development of a

clinical reference method for serum sodium.

II. DEVELOPMENT OF THE SERUM SODIUM REFERENCE METHOD

A. Organization

A panel of experts in clinical chemistry was invited to

meet at NBS in March 1974 to consider the development of

reference methods for five serum electrolytes, namely,

sodium, potassium, chloride, lithium, and magnesium. The

development of these reference methods was organized by

Dr. Robert Schaffer (NBS) aided by Dr. Ranee A. Velapoldi

(NBS). The invited experts were Dr. George N. Bowers, Jr.

(Hartford Hospital), Dr. Bradley Copeland (New England

Deaconess Hospital), Dr. Denis Rodgerson (Center for Health

"Sciences, University of California in Los Angeles), and

Dr. James White 4 (CDC)

.

Prior to the meeting, several bovine serum pools prepared

at the CDC had been analyzed for sodium by FAES, neutron

activation analyses (NAA) , and ion-exchange separation of

the sodium followed by its gravimetric measurement as sodium

sulfate (IEG). The results, summarized in Table 1, were

presented at the meeting as follows:

FAES as obtained at the CDC, by Dr. J. White,

FAES as obtained at the NBS, by Dr. R. Mavrodineanu

,

NAA as obtained at the NBS, by Dr. H. Rook, and

IEG as obtained at the NBS, by Dr. 0. Menis.

Dr. James White died after this program was well underway.

He was recommended for membership on this Experts Committee

on electrolytes by Dr. Joseph H. Boutwell (CDC). Dr. White

made significant contributions to the protocol for the reference method. His knowledge, advice, and cooperation in

all phases of this work contributed greatly to the success

of the program.
On consideration of these quite similar analytical results

and of alternative clinical laboratory procedures in use for

the determination of serum sodium, it was concluded that FAES

was the appropriate candidate methodology to evaluate as the

reference method and that its evaluation should be made using

either NAA or IEG as the definitive method; NBS, on the

basis of continued study, was to choose between NAA and IEG.

Pool

I

III

V

Table 1. Preliminary results from NBS and CDC for the

determination of serum sodium.

Na in Serum, mmol/L

b Ion-Exchange - Gravime try

124.2

138 .

154.4

Neutron Activati on

121.8

135. 5

150 . 1

Flame Atomic

Emission

Spectroscopy

d NBS

121.1

137.3

152 . 5

CDC

123 . 2

137 . 5

153 . 0

c

d

Data from 0. Menis, R. K. Bell, M. Epstein, and J. Shultz

(NBS) . Data from J. E. Suddueth, R. M. Morris, and H. L. Rook

(NBS) . Data from R. Mavrodineanu (NBS)

Data from J. White (CDC).

The experts agreed to serve as the Committee to oversee

the development of the reference method for sodium (as well as

for the other electrolytes discussed at the meeting) . The

Committee chose Dr. Bowers as chairman. Dr. White agreed to

serve as the committee's representative to work with those

at NBS who would be involved in writing the protocol for the

sodium reference method. The Committee agreed that the FAES

method should use a concentration bracketing technique rather

than calibration curves for determining sodium concentrations.

5
However, calibration curve data would be obtained as a

general check on the measurement system and to determine

which of the primary standard solutions would be used to

bracket the sodium levels in the samples being analyzed.

As goals for the candidate reference method, the maximum

bias of the method and its one-standard deviation imprecision

limit were set by the Committee at 2.0 mmol/L and 1.5 mmol/L,

respectively, for serum sodium at the 140 mmol/L level.

These goals were to be achieved by controlled, inter laboratory

tests involving a selected group of clinical chemistry

laboratories which would perform the analyses by the FAES

method according to the written protocol while NBS would

provide sodium values by the definitive method.

B. Participating Laboratories, Standards, Serum Samples,

and Definitive Method

The laboratories that were asked to participate in the

inter laboratory study were chosen to represent a wide spectrum

of clinical chemistry interests and included government

(federal and state) and hospital laboratories, and laboratories associated with suppliers of instruments and suppliers

of test and control materials. One hospital was located

outside the United States. The principal investigator at

each laboratory is named in the list below. Other scientists

in each of the laboratories who contributed to this study

are acknowledged by name in Appendix A. The list includes

three laboratories that participated only in the concluding

interlaboratory work. They were added to maintain a minimum

number of laboratories when some of the original laboratories

were unable to continue their participation. In alphabetical

order of the principal investigator, the laboratories that

participated in the interlaboratory studies are:

6
Dr. George N. Bowers, Jr.

Hartford Hospital

Hartford, CT 06115

Dr. Bradley E. Copeland

New England Deaconess Hospital

Boston, MA 02215

Professor Lorentz Eldjarn

Rikshospitalet , University of Oslo

Oslo, Norway

Dr. Ronald E. Laessig

State Laboratory of Hygiene, University of Wisconsin

Madison, WI 53706

Mr. Theodore C. Rains

Dr. Michael Epstein

National Bureau of Standards

Gaithersburg, MD 20760

Dr. Denis 0. Rodgerson

Center for Health Sciences, University of California

Los Angeles, CA 90025

Mr. William Ryan

Beckman Instruments

Fullerton, CA 92634

Mr ^onard Sideman

Pennsylvania Department of Health

Philadelphia, PA 19130

Dr. Barbara Tejeda

Food and Drug Administration

Washington, D. C. 20250
Dr. James White

Dr. Richard Carter

Center for Disease Control

Atlanta, GA 30333

Ms. Peg T. Whittemore

Instrumentation Laboratories

Lexington, MA 02173

Dr. Charles E. Willis

College of American Pathologists, Cleveland Clinic

Cleveland, OH 44106

NBS Standard Reference Material Sodium Chloride (SRM 919,

see Appendix B) was to be used as the pure primary reference

material for all analyses [7]. Seven pools of homogeneous,

sterile, bovine serum, having different concentrations of

, sodium, were prepared at the CDC by Dr. David Bayse and

Miss Sue Lewis. Samples of each pool were supplied in approximately 7-mL volumes in stoppered vials that were labeled

with computer generated random numbers. The samples, packed

in dry ice, were shipped to NBS by air and within 24 h were

placed in freezers kept at -50 °C [8]. The pools were

numbered in code from 1 to 7 according to increasing sodium

concentration

.

A definitive method based on ion-exchange separation of

sodium followed by its gravimetric determination as sodium

sulfate was developed at NBS. The definitive method is

given in Appendix C. The sodium concentrations for the

seven serum pools were determined by this procedure and the

results obtained are summarized in Table 2. The sodium concentrations for the serum pools were also determined by NAA

(procedure also outlined in Appendix C) and these supportive

results are also summarized in Table 2.

8
Table 2. Sodium concentrations for the seven serum pools

as determined by ion- exchange - gravime try ( IEG

the definitive method) , and neutron activation

analysis (NAA)

-------- [Na

+

] , mmol/L --------

Pool I EG a

, Definitive Method NAAb

1 113.2 114 7

1 121.0 121 . 7

3 129.9 130 . 7

4 136.6 137.4

5 146.3 148.6

6 153. 8 154. 7

7 158.6 158 . 7

±0.6 mmol/L for all concentrations at a 95 percent

confidence limit. Data from J. Moody (NBS)

Imprecision values at the 95 percent confidence limit

ranged from ±0.8 to 1.2 mmol/L. Data from J. E. Suddueth,

R. M. Morris, and H. L. Rook (NBS).

C. Functions of the Various Groups

The interrelationships and functions of the various

groups involved in developing FAES as a reference method for

jserum sodium are represented in figure 1. The Committee, CDC,

and NBS provided guidance and technical support for the program

and also served as participating laboratories. The Experts

Committee selected the candidate reference method, set maximum

bias and imprecision goals for an acceptable reference method,

j'assisted NBS in selecting other participating laboratories,

land reviewed all analytical results. The CDC provided the

serum pools. The participating laboratories provided the

j inter laboratory test data and critiques of the candidate

reference method protocol.

9
r Figure 1. Interrelationships and functions of the various

groups in the development of a clinical reference

method for the determination of serum sodium.

10
At NBS, Dr. R. Schaffer served as the Reference Method

Program Manager and Dr. R. A. Velapoldi served as the coordinator. The format of the round robin tests was established

within the constraints imposed by protocol requirements and

sample availability by Drs. John Mandel, Robert Paule, and

Velapoldi. Dr. Velapoldi wrote the protocol for the candidate

reference method from the outline provided by Dr. J. White.

Drs. Mandel and Paule performed the statistical evaluation

of the results from the interlaboratory tests.

D. Plan for Testing the Candidate Reference Method

The general plan was to evaluate the candidate reference

method by performing a series of interlaboratory test exercises, which would consist of a preliminary round robin test

(PRR) followed by successive round robin tests (RR) until the

goals for the reference method were reached. A main objective

of the PRR test was to allow participating laboratories to

become familiar with and comment on the protocol. Since an

evaluation of the bias was not sought in the PRR testing

phase, normal bovine serum samples [9] not having definitive

method analyses were to be used. However, interlaboratory

imprecision was to be measured. If the imprecision of the

results in the PRR was found to be small, round robin (RR)

testing would begin on samples having definitive method

sodium values.

In a RR, each participating laboratory would perform

the same analyses on two separate days: i.e., analyze a

pair of aliquots from each serum pool on each of two days

where a minimum of one day or a maximum of seven days were

to elapse between the two series of analyses. The bias and

imprecision values obtained by statistical analysis would

then be compared to the goals set by the Committee for the

reference method. If the goals were not met, additional RR

tests using samples from other pools would be conducted by

11
following the protocol or a modified form of it until the

bias and imprecision goals were reached. Revisions and

modifications to the protocol could be made after a round

robin test had been completed but would not be made after

the final RR.

Three kinds of information were to be supplied by each

participating laboratory after finishing a round robin:

1. General Data — a list of the instrumental parameters

used and comments on the protocol including problems

encountered during the analysis;

2. Calibration Curve Data — a list of the FAES relative

intensity values versus the sodium concentrations of

the standards; and

3. Valid Measurement Data — a list of the sets of data

that constituted the five 'valid measurements' (see

section IIIC-5e for discussion).

Examples of the data sheets on which the information was

collected are shown in Appendix D, Note 8.

A. General

This protocol for the analysis of serum sodium by flame

atomic emission spectroscopy provides for the optional use

of either manual or s emiautomat ed pipetting and also for one

hundred-fold or two hundred-fold dilutions of samples to

prepare working solutions. The pipetting alternatives are

discussed separately in detail whereas the dilution alternatives are not discussed since they are prescribed by the

instrument used.

Ill

.

REFERENCE METHOD PROTOCOL FOR THE DETERMINATION

OF SERUM SODIUM

B. Protocol Synopsis

The protocol must be followed exactly.
of a

day

The reference method is used to analyze four aliquots

serum: two on one day and the other two on a subsequent

1. Use an analytical balance to weigh the SRM NaCl in

appropriate quantities and to prepare a series of stock

standard sodium solutions;

2. Use either a single pipet or a pipettor- dilutor to

dilute to the sodium concentrations that are used as

working solutions for FAES a) aliquots of the serum

to be analyzed, b) ^ aliquots of the stock standard

sodium solutions, and c) the solution used as a blank;

3. Obtain calibration curve data for the working blank and

s tandards

4. Measure the emission signals of the working solutions

of the serum; select the pair of working standards

whose emission signals most closely bracket the signals

of the aliquots;

5. For each aliquot to be analyzed, obtain five valid

measurement sets by measuring the emission signals

obtained from repeated sequential measurements of the

working solutions of the low bracketing standard, the

sample, and the high bracketing standard;

6. Calculate the sodium concentration of the aliquot for

each set in the valid measurement set, by mathematical

interpolation

7. Average the five calculated values to obtain a 'single

measurement' for that aliquot; (in the statistical

analysis, each such average is designated a 'single

measurement ' )

8. Perform steps (5) through (7) for each aliquot to be

analyzed on the first day;

13
9. Repeat steps (1) through (8) on the subsequent day to

obtain the second pair of measurements needed for each

al iquo t

;

10. Average the four values obtained by the replicate

determinations to obtain the sodium concentration for

each serum.

C. Detailed Protocol

The selection of the specific alternatives of the

protocol to be used (i.e., the pipetting and the dilution)

dictates the glassware and diluent volumes needed. These

needs are summarized in the protocol or in Appendix D notes.

Stock solutions and working solutions are to be prepared at

and maintained at a room temperature that is constant within

±2 °C (see Appendix D, Note 1).

1 . Reagent Specifications

a. Water : At the time of preparation, the distilled

and/or deionized water used should exhibit a

specific resistance of at least 0.01 MQ*m at

23 ± 5 °C. At the time of use, this water should

show a flame emission signal that is less than 0.1

percent of full scale at the instrumental settings

used for the analysis. A large quantity of this

water (more than 50 L) must be available for use

as diluent and for the final rinsings of all

glassware and other apparatus that come in contact

with the solutions involved. Unless specified

otherwise, the water referred to in this protocol

is this tested water.

b. Sodium Standard Solutions : Use Standard Referenc

Material Sodium Chloride (originally issued as

SRM 919, Certificate reproduced in Appendix B) [7

certified by the National Bureau of Standards.

14
The SRM NaCl should be dried by heating at 110 °C

for four hours in a loosely capped container and

then stored in a desiccator containing CaSCU or an

equivalent desiccant.

c. Lithium carbonate, potassium chloride, hydrochloric

acid, nitric acid, chloroform, methanol and 95-

percent ethanol meeting ACS [10] (or equivalent)

specifications are to be used.

d. Dilute nitric acid (0.77 mol/L) is prepared by

making a twenty-fold dilution of concentrated HN0 3 (15.4 mol/L) with water.

2 . Glassware Specifications

a. All volumetric glassware (Appendix D, Note 2)

should be of borosilicate material and meet NBS

Class A [11] (or equivalent) specifications. All

glass or plastic surfaces that come into contact

with reagents, water, diluent, or sample must be

clean (Appendix D, Note 3)

b. Pipet tor -dilutor Device : The volumetric delivery

of the pipettor-dilutor device must have a tested

maximum inaccuracy of 2 percent and a maximum

imprecision of ±0.2 percent relative standard

deviation at the pump setting used. (The test

procedures are in Appendix D, Note 4.)

3 . Preparation of Reagents

If the instrument employed in the analyses does not

use lithium as an internal standard, water is

substituted for the aqueous lithium chloride

diluent solution in this protocol.

a . Lithium Chloride Diluent Solution (LiCl Diluent,

15 mmol/L) : The homogeneity of this solution is

critical if an internal standard instrument is to
be used. The required volume may be prepared in

ten 2-liter batches and then mixed thoroughly. For

each 2-liter volume, weigh 1.1082 g of dried Li 2 C0 3 (MW = 73.8912, Appendix D, Note 5b); however, if

NBS SRM 924 is used, weigh 1.1092 g (see Appendix D,

Note 5). Transfer the weighed Li 2 C0 3 quantitatively

into a 2-liter volumetric flask. Add water to just

cover the bottom of the flask and, with swirling,

carefully add 4 mL of concentrated HC1 to dissolve

the Li2C0 3 . Dilute to the calibration mark with

water, stopper, and mix thoroughly by inverting the

flask and shaking ten times. Repeat the inverting

and shaking steps nine more times.

1) Manual pipetting alternative: Since all standards and samples are to be diluted with this . reagent, 16 to 20 liters of the LiCl diluent should

be prepared.

2) Semiautomated pipetting alternative: Prepare

approximately six liters of the LiCl diluent.

Potassium Chloride Diluent Solution (KC1 Diluent,

4.5 mmol/L) : Weigh 0.336 g of KC1 (MW = 74.5513,

Appendix D, Note 5b) and transfer it quantitatively

to a one-liter volumetric flask. Dilute to the

calibration mark with water, stopper, invert and

mix as described above.

Sodium Standard Stock Solutions : Weigh accurately

(to 0.1 mg) approximately 0.64, 0.70, 0.76, 0.82,

0.88, and 0.94 g of dried sodium chloride (MW =

58.44277, Appendix D, Note 5b) and transfer each

quantitatively into separate 100-mL volumetric

flasks. Dissolve and dilute to the mark with the

KC1 diluent. Mix thoroughly as described above.

From the weighed quantities of NaCl taken, calculate

16
the sodium concentrations in mmol/1 to one decimal

place (an example of this step is given in Table 3)

Table 3. Sodium chloride standard solutions

.

Solution

NaCl Concentration3

mmol/L NaCl , g

1 110.1 0.6432

2 120.0 . 7010

3 k 130.0 . 7598

4 140.1 . 8186

5 150. 1 .8716

6 160.0 .9350

The NaCl concentrations were calculated using

atomic weights from the literature reference

cited in Appendix D, Note 5b.

4 . Dilution and Pipetting Procedures

a. General: A one hundred-fold or two-hundred fold

dilution is to be used as required by the instrument

employed.

b. Manual Pipetting Alternative : The blank solutions,

the standard solutions, and the samples are diluted

either one hundred-fold or two hundred- fold by

employing only one 5-mL pipet with a wash-out technique and either 500-mL or 1-liter volumetric flasks.

(The working solutions are prepared with the one

pipet and wash-out technique to eliminate errors that

may be caused by differences in drainage between

aqueous and serum solutions.) Two blanks are necessary with instruments using lithium as an internal

standard: 1) the LiCl diluent (IIIC-3a) used as the

17
blank for samples and standards, and 2) the KC1

diluent (IIIC-3b) diluted with the LiCl diluent

used as a blank for the sodium standards (see

Appendix D, Note 6)

.

(1) One Hundred-fold Dilutions: Transfer approximately 400 mL of LiCl diluent into a 500-mL volumetric flask and then add 5 mL of the sample or

stock standard solution by the procedure described

in step (3) below.

(2) Two Hundred-fold Dilutions: Transfer approximately 900 mL of LiCl diluent into a 1-liter volumetric flask and then add 5 mL of the sample or

stock standard solution by the procedure described

in step (3) below.

(3) Pipetting Procedure: Fill the 5-mL pipet to

approximately 1.0 cm above its calibration mark,

withdraw the pipet from the container, and wipe the

delivery tip with a clean, absorbent paper. Contact

the tip to the side of a clean waste container and

allow excess solution to drain until the meniscus

is at the calibrated mark on the pipet. Remove

the pipet from contact with the container and

direct the delivery tip of the pipet into the

receiver. Deliver the sample by contact of the

pipet tip with the wall inside the volumetric

flask and allow the solution to drain fully. After

drainage stops, gently expel the residual liquid.

Wash off the outside of the pipet tip into the

receiver with about 4 mL of LiCl diluent delivered,

for example, from a wash bottle or a disposable

Pasteur or similar pipet. (Caution: New, disposable

pipets need to be cleaned.) Rinse the 5-mL volumetric pipet three times by filling with fresh LiCl

diluent from a separate beaker, each time delivering

18
the contents into the receiver by drainage against

the inner wall of the flask above the liquid

level. Dilute to the calibrated volume with the

LiCl diluent and mix thoroughly.

(4) Preparation of Working Solutions:

(a) Working Blank Solution and Working Standard

Solutions: Prepare the working solutions of the

blank solution and the working 110 - , 120 - , 130 -

,

140-, 150-, and 160-mmol/L sodium standard solutions by making dilutions in appropriately labeled

volumetric flasks in the order cited. Condition

the 5-mL pipet by filling it with the solution to

be diluted. Discard this pipetful and repeat

filling and discarding twice more. Then refill

the pipet with the solution, adjust to the calibrated volume, and deliver into the volumetric

flask to be used for the dilution. Rinse the

pipet by filling it three times with the LiCl

diluent, each time delivering the rinse solution

into the volumetric flask. Fill the flask to the

calibrated volume with the LiCl diluent. Wash

out the pipet three times with water (see Appendix

D, Note 7) and expel the residual liquid.

(b) Working Sample Solutions: Condition the 5-ml

pipet with some of the sample to be diluted in

the following way: (1) draw ^2 mL of the sample

into the pipet, (2) withdraw the pipet from the

container, (3) wipe off the tip with a clean,

absorbent paper, (4) tilt the pipet to a horizontal

position, (5) allow a small volume of air to leak

in and rotate the pipet so that the conditioning

liquid wets all the internal surface to approximately 0.5 cm above the calibration mark,

(6) discard this conditioning solution, and

19
(7) repeat steps (1-6). Then prepare the working

solutions as described in sections IIIC-4b-(l) or

(2) and (3), i.e., fill the 5-mL pipet with the

sample, adjust volume to the mark, deliver, rinse

three times into the volumetric flask with LiCl

diluent, dilute to the calibrated volume, and mix.

Finally, wash out the pipet three times with water

(Appendix D, Note 7). For each of the next sample

solutions to be diluted, repeat step (4) - (b)

.

Semiautomated Pipetting Alternative : To prepare

working solutions, the blank, standard and sample

solutions are diluted either one hundred-fold or

two hundred-fold by using a pipettor- dilutor

device to deliver either 0.250 or 0.500 mL into

appropriately labeled 50-mL volumetric flasks. A

single delivery tube on the pipettor- dilutor and

the wash-out technique are used throughout. Two

blanks are prepared for instruments using lithium

as an internal standard: i.e., the LiCl diluent

(Section IIIC-3a) is used as the blank for samples

and standards and the KC1 diluent (IIIC-3b),

diluted with the LiCl diluent, is used as a blank

for the sodium standards (see Appendix D, Note 6).

(1) One Hundred-Fold Dilutions: Transfer approximately 20 mL of LiCl diluent (or water) into a

50-mL volumetric flask and then add 0.500 mL of

the appropriate solution by the procedure described

in step (3) below.

(2) Two Hundred-Fold Dilutions: Transfer approxi

mately 20 mL of LiCl diluent (or water) into a

50-mL volumetric flask and then add 0.250 mL of

the appropriate solution by the procedure described

in step (3) below.

20
(3) Procedure: The pipettor-dilutor is set to

sample either 0.250 or 0.500 mL and to dilute with

5 mL of diluent. After conditioning the pipettordilutor as in Appendix D, Note 3b, dip the delivery

tip of the pipettor-dilutor into the solution to

be transferred. Draw up the desired volume of

solution (0.250 or 0.500 mL) . Care must be taken

to avoid air bubbles in the tubing before or

during this operation. Withdraw the tip of the

delivery tube from the solution, touch the tip to

the container side, and remove the container.

With care not to touch the open end of the tip of

the tube, wipe the outside of the delivery tube,

direct the tip of the tube into the 50-mL volumetric flask, and deliver the aliquot and diluent

solution into the flask. Rinse the delivery tube

twice more by delivering two additional 5-mL portions of diluent through the tube into the 50-mL

volumetric flask. [NOTE : To minimize foaming and

spattering, deliver the stream of solution and

diluent on the wall inside the neck of the flask.]

After delivery is complete, touch the tip of the

tube to the inside wall of the flask to transfer

any solution remaining outside the tube. Remove

the volumetric flask, dilute to the calibrated

volume with the appropriate diluent, and mix.

(4) Solution Preparation:

(a) Prepare the working blank, standard, and

sample solutions by the procedures described in

Sections C(l), (2), and (3).

(b) At the conclusion of the dilution procedure,

appropriately labeled flasks with the following

working solutions should be ready for analysis:

21
(1) For the Manual Pipetting Alternative:

(a)

(b)

(c)

One (or two) working blank(s);

Six working standards;

A working solution for each serum

sample to be analyzed.

(2) For the Semiautomated Pipetting Alternative

(a) One (or two) working blank(s)

;

(b) Six working standards;

(c) A working solution for each serum

(5) Flame Atomic Emission Spectroscopy Measurement

Procedures: It is not possible to provide detailed

instructions for each type of instrument to assure

necessary instrument stability, linearity, flame

conditions, etc. The operator must be familiar

with the instrument used. The instrument should

meet all the manufacturer's specifications. In

general, the accuracy of the method cannot be

attained unless the instrument is in optimum

operating condition. Air and propane are used as

oxidant and fuel, respectively.

The instruments that are currently in use for FAES

measurements may be classified into two groups:

internal standard and non- internal standard instruments. Each group is considered briefly.

For the internal standard instruments, the concentration of the internal standard LiCl must be kept

uniform throughout the analysis since the sodium

emission signal is measured relative to the lithium

emission signal.

sample to be analyzed.

22
Internal Standard Instruments:

Instrument Adjustment:

The most commonly used internal standard

instruments employ filter ' monochromators '

,

automatic gas-flow control systems and automatic ignition devices. Choose the correct

series of filters for the analyses. After

starting the instrument, turn on the air

supply (adjust to manufacturer's recommended

pressure) , open the valve on the propane fuel

tank, and allow the instrument to warm-up for

at least 15 minutes while aspirating the

LiCl diluent. Check the flame appearance and

aspiration rate to assure that the nebulizer

burner system is free of foreign materials.

Instrument Stability:

Determine the stability and repeatability of

the instrument as follows:

(a) Adjust the instrument to a zero reading

while nebulizing the LiCl diluent. [NOTE:

Always nebulize LiCl diluent when measurements

of the working blank, standard or sample

solutions are not being made. Adjust the

instrument so that the LiCl diluent reads

'zero' at all times.]

(b) Nebulize the working sodium standard

solution obtained from the 160 mmol/L standard

solution and adjust direct read-out instruments

so that a reading of 160.0 units is observed.

(c) Check the instrument zero with LiCl

diluent and readjust as necessary.

23
(d) Repeat steps (2) (a) -(c) until stable

conditions are achieved. Readings for the

same solution should agree within 0.5 percent

of full scale.

Non-Internal Standard Instruments :

Instrumental Adjustments:

(a) After turning on the instrument and

adjusting the wavelength to 589 nm, adjust

the slit as recommended by the manufacturer.

(b) Open the propane and air supply valves

and adjust the secondary regulators as recommended by the manufacturer.

(c) Ignite the burner and adjust the flow

rates for the fuel and oxidant as recommended

for the instrument. Check the flame appearance and nebulization rate to assure that the

nebulizer burner system is free of foreign

material s

.

(d) Nebulize water into the flame for at

least 10 min; then make a fine adjustment of

wavelength by nebulizing one of the working

standards and adjusting the wavelength

selector until a maximum signal is obtained.

Instrument Stability:

Determine the stability and repeatability of

the instrument as follows:

(a) Adjust the instrument to zero while nebulizing water. [NOTE: Always nebulize water

when measurements of working standard, blank,

or sample solutions are not being made. Water

should give a reading of 'zero' at all times.]

24
(b) Nebulize the working standard obtained

from dilution of the 160 mmol/L standard and

adjust the instrumental gain so that for

digital read-out instruments a reading of at

least 2.000 units is observed.

(c) Check the instrument zero with water and

readjust as necessary.

(d) Repeat steps (2) (a) -(c) until stable

conditions are achieved. Readings should

reproduce within 0.5 percent of full scale.

c . Determination of the Calibration Curve :

(1) Nebulize the working solutions of the blank

and the sodium standards and record their relative

intensity values. (A typical data sheet is given

in Appendix D .

)

(2) Subtract the value for the blank from the

values obtained with the standard solutions, and

plot .these corrected relative intensity values

versus the calculated sodium concentrations on

rectilinear graph paper. A typical calibration

curve is shown in figure 2. The calibration curve,

using a least squares linear fit, should show a

standard deviation of fit of 1 percent or less.

25
SODIUM CONCENTRATION, mmol/L

Figure 2. Typical calibration curve for the determination of

serum sodium by flame atomic emission spectroscopy.

26
The standard deviation of fit can be calculated

from the deviations, d^, of the N points from the

least squares fitted calibration line:

If on visual inspection, one point of the plot

exhibits a large residual from a smooth curve

drawn through the remaining points , remeasure that

standard solution. If the value for the solution

continues to exhibit the large deviation, prepare

that standard solution again, remeasure it, and

compare the values obtained, as in steps c(l) and

(2). (See Statistical Analysis Section V-A-3.)

d . Sample Measurements :

(1) Nebulize a working sample solution and select

the two working standard solutions whose emission

intensities most closely bracket that of the

sample

(2) Nebulize the lower working standard, the

working sample, and the higher working standard in

that order and record each reading in the set.

(3) Repeat step d(2) until 5 valid sets are

obtained, as illustrated in section e, below.

(4) Repeat steps d(l) , (2) , and (3) for all of

the samples.

S fit (1)

27
e . Valid Sets of Readings :

Sets of readings are considered valid if the

following condition is met:

The emission intensities for the sample and the

two standards in a set may not differ by more than

2 percent from any of the corresponding values in

the previous valid set. [NOTE: The first set

measured is considered to be valid. Non-valid

sets are discarded.]

Five valid sets must be obtained to complete a

measurement. For example: In Table 4, set 2 is

valid since each difference between the intensities

for the Low Standard (Set2~Set^ = -0.3), the Sample

(Set2~SetL = -0.6) and the High Standard (Set2~

Set-^ = 0.5) is less than 2 percent. Note, however,

that set 4 is not valid because two differences,

i.e., between the Low Standard values (Set^-Set,

= -2.9), and Sample values (Set^-Set^ = -2.8),

are outside the 2 percent limit. Just one such

difference would have disqualified set 4. Thus,

sets 1, 2, 3, 5, and 6 comprise the group of 5

valid sets.

Table 4. Example of intensity values for sets of

readings using a direct read-out instrument.

Set

Low Standard

130.0 mmol/L Sample

High Standard

140.0 mmol/L

1 130. 7 137.4 140 . 6

2 130. 4 136. 8 140. 1

3 131.0 137.5 140. 5

4 128.1 134. 7 139 . 6

5 130. 2 136. 8 140. 2

6 130.4 137.

1

140. 5

28
f . Data Recording and Calculations :

(1) On the data sheet, record the concentrations

of the standard solutions in mmol/L of sodium to

four significant figures and the measured relative

intensity values to as many figures as given by

the instrument.

(2) Calculate the concentration C of sodium

present in the sample in mmol/L by mathematical

interpolation as follows:

(C

?

-C

q )(Y-X ) C = C, + — — (2)

where

C is the sample concentration of sodium in

mmol/L

,

C-^ is the low standard concentration of sodium

in mmol/L,

is the high standard concentration of sodium

in mmol/L,

Y is the relative emission intensity of the

sample minus that of the blank (the LiCl

diluent or water reading that was initially

set at ' 0 '

)

X-^ is the relative emission intensity of the low

standard minus both blanks (the diluted potassium chloride solution blank and the LiCl

diluent blank) , and

X2 is the relative emission intensity of the

high standard minus both blanks.

29
(3) Record the calculated C values to four

significant figures in the column provided on the

data sheet.

(4) Average the results for the four aliquots of

the serum analyzed to obtain the 'final concentration ' .

IV. RESULTS AND STATISTICAL ANALYSIS

The main objective of the statistical analyses of the

round robin data is to derive measures of precision and

accuracy for the manual and semiautomated versions of the

reference method. Precision is characterized by the variability of the protocol measurements within a single laboraA tory, 0^ii\l j.ji'

an<^ ^ the total variability of a laboratory's

protocol measurements, °^ 0 ^ 3i iThis latter uncertainty

.includes the variability of 'between laboratory' measurements. Accuracy relates to the comparison between reference

method and definitive method values and is related to the

magnitude of the bias.

Each reported data point (test result) is the end

product of five valid flame atomic emission spectrometer

readings, the number of valid readings specified by the

protocol. For simplicity of discussion, each reported data

point is referred to as a s ingle measurement , meaning that

each is the product of a single run-through of the protocol.

When "replication" is mentioned, replication of the entire

protocol process is meant, and "replication error" thus

refers to the variability among the end results of repeated

run-throughs of the protocol. Each round robin is discussed

separately; a detailed statistical analysis was performed on

the results from RRII.

30
A. Round Robin Results

1. Preliminary Round Robin (Dates Run: March-May

1975)

a. Objectives: To allow the participating laboratories to become familiar with and comment on the

protocol and to determine inter laboratory precision.

b. Samples : Three vials, each containing a sample

from the same serum pool. Each participating

laboratory was^ to analyze a single portion of each

sample within one day.

c. Procedure : The manual pipetting protocol was

used

d. Data: The three data points reported by the

individual laboratories are summarized in Table 5.

The data are presented graphically in figure 3 as

the percent differences from the collective average

of the reported values. All reported values are

within ±1.5 percent of the collective average with

a standard deviation of ±0.8 mmol/L. No major

problems were encountered in the performance of

the protocol.

e. Direction: On examining these results with the

statisticians and the Experts Committee, it was

concluded that a round robin should be undertaken

using samples with sodium concentration values

determined by the definitive method.

31
Table 5. Serum sodium concentrations reported by the

participating laboratories for the Preliminary

Round Robin, manual pipetting protocol. ------- [Na

+

], mmol/L a -------

Laboratory Vial 1 Vial 2 Vial 3 Laboratory Average

3 147.0 148.9 149.0 148.3

4 147.7 146.7 147.4 147.3

5 148.8 148.9 148.5 148.7

7 148.2 148.0 148.0 148.1

8 147.0 148.2 147.2 147.5

9 150.1 150.1 150.1 150.1

10 148.4 148.1 148.1 148.2

11 148.2 148.4 147.9 148.

2

Collective Average 148.3

Each value represents a single measurement on a sample.

2. Round Robin I (RRI . Dates Run: June-August 1975).

a. Ob j ect ives : To test the full protocol on serum

samples having a wider range of sodium values and

determine the imprecision and bias of the test

results

.

b. Samples : RRI was a test series run on 12 samples — four vials of each of three different concentrations (Pools 2, 4, and 5). Each laboratory was to

analyze two vials of each pool on one day and the

remaining pairs of samples on a subsequent day

with the requirement that a minimum of one day and

a maximum of seven days should elapse between

analyses

.

c. Protocol : The manual pipetting protocol was used.

32
EE CS

U O

cc o

1 -

0

1 -

-2

LABORATORY NUMBER

Figure 3. Percent deviations of individual results from the

collective average of the measurements obtained

in the Preliminary Round Robin test.

33
D ata : The single-measurement data reported by the

laboratories are summarized in Table 6. The data

are presented graphically in figure 4 as percent

deviations of each one-day 'single measurement'

average from the definitive method value. Except

for laboratory 8 which showed a large error in a

single determination on one sample from pool 5 on

the subsequent day, all the values reported by the

laboratories were within ±1.5 percent of the

definitive method sodium values. Most of the

laboratories reported values that fell both above

and below the definitive method value.

Comments and Protocol Deviations : The following

laboratory comments germane to changing the

protocol or signifying deviations from the protocol

were received:

(1) Lab 3 : Used 1-mL samples and standards and

diluted to 200 mL-not 5 mL diluted to 1000

mL as required by the protocol;

(2) Lab 4 : Encountered instrument problems;

consequently, working samples and standards

had been prepared 18 h before being measured.

(3) Lab 5 : Encountered instrument problems;

Suggested linearity requirement be set for

calibration curve.

(4) Lab 8 : Lost one sample. Thus on last day,

the value for pool 5 is for a single sample.

(5) Labs 4 and 15 : Recommended that a semiautomated pipetting version of the protocol

be evaluated.

34
Table 6. Concentrations of serum sodium reported by the

participating laboratories for Round Robin I,

manual pipetting protocol.

Laboratory Pool 2

[Na] , mmol/L"

Pool 4 Pool 6

Day 1 Day 2 Day 11 Day •70 Day r Day 2

3 120. 28 120. 94 135. 66 136. 86 147. 54 147. 08

t 9 n 12 0. 7 O

/ O 12 0. 1 9 1 Z

1 7 c lob . 54 1 36 . / 2 14 6. 98 14 7. 52

4 121. 12 122. 14 136. 80 137. 60 146. 92 147. 88

19 1 1 Z 1 . 9 O Z O 1 z z

1 0

1 7 C

i JO . o 0 loo. 16 146 . 9 0

1 A 1 14 / . 7 A

1 4

5 120. 68 119. 84 135. 56 135. 76 147. 30 147. 44

1 1 n 1 1 y

y u 1 z uO 0 loo. o U 1 0 o . U 0 14/. n 9 U Z 1/17 14 / . 9 O Z o

7 120. 85 120. 44 136. 31 135. 97 147. 59 147. 17

19 9 1 Z Z . i y 1 z u . Q /I y 4 100. 1 7A 1 X 1 01 7 A 100. n 9 U Z 1/17 14/. 9 7 Z / 1/17 14/. n n U U

8 120. 08, 119. 28 136. 36 134. 92 147. 42 153. 7

b b i 9 n ± z u . n /i 10 0. n a U 4

17/1 10 4. 7 Q

/ O 1/17 14/. 9 9 Z Z

9 121. 00 120. 60 137. 32 136. 50 147. 44 147. 02

121. 00 120. 90 137. 00 136. 54 147. 50 147. 22

10 121. 44 121. 14 136. 80 136. 08 148 . 00 147. 34

121. 20 120. 84 135. 20 136. 30 147. 34 147. 68

11 120. 90 120. 48 136. 54 136. 08 147. 44 147. 28

120. 94 120. 80 136. 00 136. 00 147. 42 147. 24

13 120. 42 120. 88 136. 52 136. 34 147. 36 147. 32

120. 22 120. 64 136. 32 137. 00 147. 60 147. 16

Definitive

Method Values 121 . 0 136 .6 146 . 3

Each value is the single measurement average of five valid

FAES readings made on a single sample dilution.

Values not reported.

35
CO

(73

oo CO

LT5 5

CM

CO

CO CM «— «— CM

aniVA Q0H13IAI 3AI1INIJ3Q 3HI

lAIOUd N0I1VIA3Q !N33H3d

(1

1

5h

• r~l 03 CD

+-* \T rH > in

• rn •H o 0)

(H

»—

i

6 jo +->

* r~l •H 03

f |

1 If) U i X 03

eM, CJ H Tj

UJ rH +-> 03 U

CD p

p t/) rH CD •H p

o cr

cd •H

S-h1 +-> H3 t/i

t i i H—

1

+-> 03 CD X

U p

t/j +—i i

X> •H i—

1

\—i V)

rl l UJ T3 CD H

jr: t; CD rr(

\ij •H H <H 0) t>^

r-* r-> 03

I/) H P. TO 03

(1

}

0) M

nd rH •H to rH

I-H (/) •H

CD X rH m

rH rH CD

• f—

(

03 O X> CD S rC

(/) 03 +-> rVMh i—l fH P

O o CD n—

(

o x CD 4-> 03 rH H

P-H cd 6 •H o

cu X rH <S) <D

A-i rH «4H M T3

03 rH

03

f i i t—1 o3 +> to rH X

(J o3 CD CD rH

CD H3 rH CD

(/) e >

H 1) p H

o P pj P

rH 4-> •H U

4-* P >> CD TO !/) O •H rH Ph

• rH 0 -M 03 O in P e +-> CD i—

1

+-> CD 03 rH

rr-t o3 X rH rH > CD O r\ s CD X m

03

<D O M rH i—

1

U P

fH +-> n3 CD CO

CD O rC CD

CX, 6 o3 U

CD

rHP

Ml

36
Direction : A semi automated pipetting alternative

was written into the protocol. A second round

robin test (RRII) was to be run using both the

semiautomated and manual pipetting alternatives.

Test samples would cover the full range of sodium

concentrations

.

Round Robin II : (RRII. Dates Run: November 1975 - February 1976)

General : The addition of the semiautomated pipetting alternative to RRII was considered advantageous

because the manual and semiautomated pipetting

versions could be evaluated simultaneously on the

same serum samples. The semiautomated version

would be used in suitably equipped laboratories

with consequent economies in reagents and labor;

whereas the manual version would be used in laboratories having equipment basic to the method but

lacking the appropriate semiautomated sampling

device

A review and test of the capabilities of positive

displacement pipettor-dilutors demonstrated that

the precision and accuracy requirements listed in

the protocol could be met. Consequently, a method

r testing the pipettor-dilutor was included in

tuc protocol.

Ob j ect ive : To test both the manual and semiautomated pipetting alternatives of the protocol on

samples with sodium concentrations over the

nominal range of 110 to 160 mmol/L.

37
Samples : RRII was a test series run on a total of

20 samples — four vials of each of five different

concentrations (Pools 1, 3, 4, 5, and 7). Each

laboratory was to analyze two vials of each concentration on the first day and the remaining pairs

of samples after the elapse of a minimum of one

day and a maximum of seven days.

Protocol : The manual and semiautomated pipetting

versions of the protocol were used.

Data and Statistical Analysis : Results from RRII

are given in Tables 7-8 and illustrated in figures

5-6. The data are presented as two-way tables in

which the rows represent the different participating laboratories and the columns represent the

different sample pools. The sample pool concentrations ranged from approximately 110 to 160

millimoles of sodium per liter of serum. The

results for the manual procedure and for the

semiautomated procedure are listed separately, and

all single measurements reported are included in

the tables. The definitive method values for the

sodium concentrations in the sample pools are

listed at the bottom of Tables 7-8.

A detailed statistical analysis was made. First

the data were inspected by calculating the percent

deviation of each day's results for each ppol from

an average for that sample pool. This procedure

showed that the manual procedure results of Laboratory 15 differed greatly from the laboratory

averaged pool results. [During this RR, Laboratory

15 encountered instrumental stability problems.

It was reluctant to provide this data, but could

not reschedule a rerun of the RR. Laboratory 15

38
Table 7. Concentrations of serum sodium reported by the

participating laboratories for Round Robin II,

manual pipetting protocol. -------- [Na] , mmol/L --------

^oratory" p^ p^ p^ p^ p^

4-1 113.68 129.36 136.44 146.94 157.86

113.46 129.38 136.26 146.98 156.96

4- 2 113.14 129.12 135.60 146.78 157.72

113.50 128.92 135.34 146.70 157.42

t 5- 1 113.90 129.90 136.48 152.86 157.58

113.90 129.60 136.22 146.76 157.66

.J ? 1 13 78 129 . 58 136 . 28 147 . 96 157 . 94

114. 00 129. 76 136. 58 148 . 06 157. 80

7 -

/ 1X 113 64 128 58 135 . 86 146 . 74 158 . 26

114. 22 129 . 26 135. 86 147 . 06 157 . 68

7 - i 113 38 129 . 46 135

48 146 . 44 157 . 88

113. 50 129 . 06 135. 88 146. 52 157 . 56

8- 1 113

66 130 . 64 134

76 146

92 159 . 32

113 . 72 128 . 82 137 . 96 147 . 74 157 . 10

8- 2 112 . 08 129. 66 134. 40 146. 06 158. 24

114. 30 128. 38 134 . 92 144. 92 156 . 68

9- 1 113. 02 128. 66 135. 92 146. 82 157 . 94

112 . 94 128. 22 136. 44 147. 30 158. 48

9- 2 112. 66 128. 22 136. 22 146. 46 157 . 06

113. 36 128. 42 137 . 18 146. 72 156. 88

11- 1 113. 86 129. 43 136. 56 147. 29 158. 73

113. 92 129. 45 136. 12 147. 43 156. 88

11- 2 113. 62 129 . 71 137. 46 145. 26 157 . 47

113. 74 129. 44 136. 54 146. 32 157 . 97

13- 1 113. 50 130. 62 136. 94 148 . 20 158 . 46

113. 58 129. 64 138. 43 149 . 00 158 . 24

13- 2 113. 14 129. 00 136. 20 147. 12 158 . 04

113. 44 129. 60 136. 80 147. 88 158 . 12

continued

39
Continuation of Table 7. -------- [Na] , mmol/L ------- -|

Laboratory5

Pool x Pool 3 Pool 4 Pool 5 Pool 7

15-lb 118.46 133.26 140.22 149.54 161.83

118.94 129.63 139.23 149.43 162.61

15 -

2

b 118.33 133.77 140.67 150.00 160.61

117.57 134.53 142.27 150.89 160.93

Definitive

Method Values 113.2 129.9 136.6 146.3 158.6

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

k These results are not included in any pooled values, or

final results.

40
Table 8. Concentrations of serum sodium reported by the

participating laboratories for Round Robin II,

semiautomated pipetting protocol.

laboratory5

1-1

1- 2

2- 1

2-2

4-1

4-2

9-1

9-2

[Na] , mmol/L

Pool 1 Pool 3 Pool 4 Pool 5 Pool 7

113. 56 129 . 12 135 . 82 146 . 88 158 . 02

114. 12 129 . 32 136. 14 147. 52 157 . 60

114. 00 130 . 06 136. 10 147. 14 157 . 98

113. 94 129. 90 136. 04 147 . 28 157 . 88

113. 80 129 . 45 135. 81 145. 76 156 . 87

113. 61 129 . 09 134. 67 146. 57 157 . 18

114. 68 130. 28 137 . 29 147 . 78 158 . 42

113. 51 129 . 99 136. 42 147 . 76 158 . 07

113. 14 129. 50 135. 54 146. 32 156. 70

113 . 16 129 . 12 .135. 44 146. 48 156 . 82

nj . 1 9 1 L 19 0 i z y . 9 A 136. 38 ±40. 1 A fi Q 9 o L 10/. 1^7 C 0 J o 113. 30 129. 78 135. 80 147 . 80 157 . 56

112. 76 128. 40 136. 88 146. 36 157 . 24

114. 42 128 . 54 138. 54 146 . 54 157 . 58

113. 10 128. 82 136. 44 147 . 34 157 . 58

113. 62 128. 58 136. 60 146. 82 157 . 48

10- 1 113. 72 129. 54 136. 02 147. 62 158 . 28

113. 70 129. 26 135. 36 146. 96 158 . 12

10- 2 113. 22 129 . 04 135. 78 146. 54 157 . 18

113. 08 129. 72 136. 42 146. 60 157 . 20

11- 1 114. 77 131. 00 137 . 40 148. 19 159 . 16

115 . 69 129 . 95 137 . 01 149. 10 159 . 83

11- 2 113. 86 130. 43 137. 02 147. 83 158 . 31

114 . 20 130. 30 137 . 32 147. 61 158 . 51

cont inued

41
Continuation of Table 8. -------- [Na] , mmol/L ------- -I

Laboratory" pool ± pQol 3 poQl 4 pQol 5 pQol ?

a

15-1 113.56 128.59 135.00 146.30 157.31

113.80 129.55 134.49 146.46 157.66

15-2 114.84 128.98 136.12 146.18 156.11

114.60 130.70 136.04 145.15 155.95

Definitive

Method Values 113.2 129.9 136.6 146.3 158.6

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

was persuaded to send in its data. Their data

was found to be consistent; however, it showed a

large blank for the manual pipetting procedure

(the only lab to do so for any procedure) . If the

blank could be ignored, the results would bracket

the definitive method values.] Laboratory 15 data

are included for information only [12] but were

not used to calculate the manual procedure pool

averages. The percent deviation values were

recalculated; these percent deviation values for

all laboratories are listed in Table 9. The

semiautomated procedure percent deviation values

are reported in Table 10.
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44
Table 9. Percent deviations from averages for sodium in

serum from Round Robin II, manual pipetting

protocol

cl Laboratory Pool 1 Pool 3 Pool 4 Pool 5 Pool

4-1 H X .04 . nu 7/ o 7 - . 1 J - . Z 4

4-t 7z . 18 - 7 0 ^ ft x n - . 14

c; _ i

. 33 i JUXf\ . nu 7/ 1 7ft 1 . / o - i n . 1 u

J

c, - ?z, . 32 X 0 1 X . X *j . D 0 . uo

7-1 / X . 36 . Z, O- . 7z Qy

7 n . Z Ui ? . 1 Z 7-7 1 L . 07 ' - 0 7 - 4 7 . f Z -.45/I ft - o /i . U 4

ftO

- 1X .15 . j j . U O

i n . 1 u7 7 . Z /

fto

- 7z, .29 - 7ft . Z, o

- 11.1/17 1 1 t: - 1 . 1 j - . Z U

Q - 1 z> X .48 • U J

- 0 c: . U J

n q . u y? 7 . Z /

Q - ?z. 4 S - 7 4 . j j -

. 414- X . j Z 11-1 . 32 .12 . 06 . 12 .01

11-2 . 23 . 55 - . 95 - . 04

13-1 .02 . 66 1.05 . 96 . 36

13-2 . 21 . 01 . 18 . 21 . 19

15-1 4 .56 1.67 2. 55 1. 56 2. 81

15-2 3 .90 3. 77 3. 83 2. 21 1. 89

Averages

used in 113 . 52 129. 28 136. 25 147. 19 157.78

b calculations

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

k The averages do not include data from Laboratory 15.

45
Table 10. Percent deviations

in serum from Round

pipetting protocol.

from averages for sodium

Robin II, semiautomated

Laboratory9, Pool 1 Pool 3 Pool 4 Pool 5 Pool

1-1 . 02 - . 20 - .17 . 14 .10

1-2 . 13 . 39 - . 10 . 15 . 18

2-1 - . 10 - . 16 - . 71 - . 56 - .40

2-2 . 24 . 51 .47 . 53 . 38

A 1 4-1 - . 59 - . 13 - . 53 - .40 - .56

A O 4-2 - . 53 . 03 - . 09 . 22 - .05

9-1 - . 20 - . 77 1 . 10 - .37 - .15

9-2 - .40 - . 60 . 23 . 06 - .08

10-1 - . 09 - . 06 - . 38 . 20 .35

10-2 - . 59 - . 46 - . 08 - . 2. 3 \ -.29

11-1 1 . 24 . 77 . 73 1 .13 1.17

11-2 . 19 . 69 . 70 . 50 .48

15-1 - 12 - 31 -1.08 - 41 - • J-10u 15-2 . 79 . 28 - . 10 . - . 90 -1.05

Averages

used in , calculations

113.82 129.47 136. 21 146. 99 157.65

The laboratory designation consists of two parts

the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

The averages include results obtained only from the

semiautomated procedure.

46
A comparison was next made of the ability of each

laboratory to replicate its values relative to

that of the average replication ability of all

laboratories. This was done by comparing the

standard deviation for each day's measurements for

each pool against the laboratory averaged standard

deviation for that pool (see Tables 11-12). If

all of the participating laboratories were of the

same population in regard to replication error,

the standard deviation ratios reported in Tables

11-12 would be larger than 2.40 only about one

percent of the time. In practice it is not too

uncommon to encounter a few standard deviation

ratios that are somewhat larger than 2.40, as this

is a reflection of some heterogeneity of the

laboratory population in regard to replication

error. (As long as the standard deviation ratios

are not too large, this is normally not used as a

reason for rejection of a laboratory. It is

advised, however, that laboratories with large

standard deviation ratios should reexamine their

procedures for possible sources of excessive

replication error.)

47
Table 11. Ratios of standard deviations to average standar

deviations for sodium in serum from Round Robin

II, manual pipetting protocol.

Laboratory Pool 1 Pool 3 Pool 4 Pool 5 Pool

4-1 .60 . 04 . 25 . 05 1. 33

4-2 .98 .38 . 36 . 09 .44

5-1 . 00 .57 . 36 7. 01 .12

5-2 .60 .34 .42 .11 .21

7 -a 1 . 59 1 .29 . 00 . 37 . 86

7-2 . 33 . 76 . 56 . 09 .47

8-1 . 16 3.45 4.46 .94 3.28

8-2 6.07 2.42 . 72 1. 31 2 . 31

9-1 .22 . 83 . 72 .55 . 80

9-2 1.91 .38 1. 34 .30 .27

11-1 .16 .04 .61 .16 2 . 73

11-2 . 33 . 51 1. 28 1.22 .74

13-1 .22 l.<86 2. 08 .92 .33

13-2 .82 1 . 14 .84 .87 .12

15-l b1 . 31 6.88 1. 38 .13 1.15

15-2 b 2.07 1. 44 2.23 1.02 .47

Average

Standard

Deviation, 0 .259 .373 .508 .615 .478

mmol/L

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

The results from this laboratory were not included in any

pooled values.

c The average standard deviations do not include

Laboratory 15 values.

48
Table 12. Ratios of standard deviations to average standard

deviations for sodium in serum from Round Robin

II, semiautomated pipetting protocol.

Laboratory Pool 1 Pool 3 Pool 4 Pool 5 Pool 7

1-1 1 .25 .41 . 60 1 . 38 1. 77

1-2 . 13 . 33 . 11 . 30 .42

2-1 .42 . 74 2. 14 1 . 75 1.31

2-2 2.62 . 60 1.63 . 04 1.48

4-1 .04 . 79 . 19 . 35 . 51

4-2 .40 i. 12 1.09 2 . 11 . 08

9-1 3. 71 . 29 3. 11 . 39 1 .43

9-2 1.16 . 50 . 30 1.12 .42

10-1 . 04 . 58 1 . 24 1.42 . 67

10-2 . 31 . 66 1 . 20 .13 .08

ii i Z . U 09 17 Z . i /

"7 T 1 OA Z . o5

11-2 . 76 . 27 . 56 .47 . 84

15-1 . 54 1 . 99 . 96 . 35 1 . 48

15-2 . 54 3. 56 .15 2 . 22 .67

Average

Standard , Deviation

,

•

. 316 . 342 . 377 .328 . 168

mmol/L

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

The average standard deviations include results obtained

only from the semiautomated procedure.

49
The calculations on round robin II data were made

on the data in the two-way tables using a weighted

least squares fit to the following model [13] :

Y. ., = y . + 3- (X. - X) + X. . + e. ., (3) ljk K

i i

( j

J ij ijk 1

where :

Y. ., = the sample concentration reported by the i

1 3 K th laboratory, for the j sample, and for the

k^ replicate measurement,

y . = a constant factor associated with the

i

average bias for laboratory i,

3^ = a slope factor for laboratory i_, expressing

the relation of bias to concentration,

X. = the observed average concentration for

sample pool j (this average is taken over

all laboratories)

,

X = the weighted average concentration for all

samples (this average is taken over all

laboratories and over all sample pools)

,

X^j = a random sample interference factor (matrix

effect) for laboratory i and sample pool j,

and

= a random replication error.

The above model is quite general and extensive

experience has shown that it is well suited to

describe a number of measurement factors in interlaboratory tests [14].

50
Weighted analyses of variance were made on the data

in the two-way tables using the fits to the above

model. (A modified version of the weighting

procedure reported in reference 15 was used.)

From the analyses it is possible to derive the

following estimates for three components of

variability, each characterized by its standard

deviation

°e

= a e(repl)

= t ^ie uncer 'ta i- nt y observed for

replicate measurements in a given

laboratory on a given day,

°D

= a Day

= t *ie additional uncertainty that is

observed when measurements are

made on different days within the

same laboratory, and

a

L

= °Lab= t ^ie a ^ditional uncertainty that is

observed when measurements are

made by different laboratories.

These components of standard deviation are given

in Table 13.

From the analyses, it was observed that the ranges

of values for the o

£

and components of standard

deviation were small, and that the values did not

depend significantly on the sodium concentration.

Because of this, only average a and a n values are

reported. The trend of as a function of concentration, however, was large enough to justify

reporting smoothed values as a function of

concentration.

51
Table 13. Components of standard deviation in mmol/L for

sodium in serum, Round Robin II.

Manual Pipetting Protocol

(Pooled Results from 7 Laboratories)

Sodium Level, mmol/L g

e (Repl . ) °Day °Lab

113.5 .73 0 .36

129.3 .73 0 .42

136.3 .73 0 .45

147.2 .73 0 .50

157.8 .73 0 .54

Semiautomated Pipetting Protocol

(Pooled Results from 7 Laboratories)

Sodium Level, mmo 1/L e(Repl.) u Day u Lab

113.8 .41 .51 .20

129.5 .41 .51 .25

136.2 .41 .51 .36

147.0 .41 .51 .55

157.6 .41 .51 .75

52
Because of the relatively small size of the sodium

round robin tests we must consider the individual

components of standard deviation to be only

advisory in nature. The nature of analysis of

variance calculations is such that , if one obtains

an overly large component of replication a

£

due to

restricted rejection of outliers, a low value for

CT Day resul1:s ' I n other words, restricted rejection

of values having large deviations may result in

some misclassif icat ion of the components of variability. We judge, from past experience, that this

may have occurred for the (°

£ > °-Q a y) pair for the

sodium manual procedure. This is not of great

concern since the final practical statements of

uncertainty involve the recombination of these

components. One such final statement is °

VJ i^]l j_ n

f the expected uncertainty within a single laboratory

from running the complete protocol (2 replicates/day

for 2 days). 7 J The a . . results are reported in within r columns three and seven in the top section of

Table 14, and are calculated as follows:

"2 "2

within

These are the expected uncertainties that a single

average laboratory could see by repeating the

complete protocol a number of times and observing

the variability of its results. This a -

; u is within

not the total uncertainty since there is also a

"between laboratory" component, a

^ a

^. The standard

deviation of the total uncertainty expected as a

result of a single laboratory running the complete

protocol is calculated as follows:

53
Table 14. Summary of imprecision and bias results in mmol/L for

sodium in serum, Round Robin II. ____________ i0 Precision ----------

Manual Semiautomated

Pipetting Protocol Pipetting Protocol

Na Level

a

comp °within °total Goal °total °within a

comp

114 .19 .36 .51 1.5 .46 .41 .18

129 .21 .36 .56 1.5 .48 .41 .18

136 .22 .36 .58 1.5 .55 .41 .21

147 .23 .36 .62 1.5 .69 .41 .26

158 .25 .36 .65 1.5 .86 .41 .33

Accuracy

Na Level

114

129

136

147

158

Manual

Pipetting Protocol

Round Robin

Composite Bias

^obs'-W

.3

-.6

-.3

.9

-.8

Goal

±2.0

±2.0

±2.0

±2.0

±2.0

Semiautomated

Pipetting Protocol

Round Robin

Composite Bias

(Xobs" X^

.6

-.5

-.4

.7

-1.0

54
a Total V"

2 ~ 2

a — D ^ 2 + — + a

L

(5)

Columns four and six in the top section of Table

14 list such standard deviations for the manual

and semiautomated data from round robin II. The

precision goal for the reference method is listed

in column five. Comparison of the tabulated

standard deviations and the goal shows that the

precision goal has been met at the nominal serum

sodium value of 140 mmol/L.

The standard errors of the round robin composite

values are given in columns two and eight of the

top section of Table 14. These standard errors

are calculated from the components of standard

deviation as follows:

The bottom section of Table 14 lists the observed

biases between the reference method round robin

composite values and the definitive method values.

The observed biases are within the goals for the

reference method.

Table 15 lists the composite round robin II sample

averages ± twice the standard error for the manual

and for the semiautomated versions, and for the

corresponding definitive method values. The

composite round robin values are given to two

decimal places as these numbers express the averages

of the numerous measurements made in the round

robin. The definitive method values are given to

Comp

(6)

55
Table 15. Summary of sodium in serum values ±2 standard

errors

.

Round Robin II - Composite Values

(mmol/L)

Definitive Method

Values (mmol/L)

Manual Semiautomated

113.52 ± 0.38 113.82 ± 0.36 113.2 ± 0.6 a

129.28 ± 0.42 129.47 ± 0. 36 129.9 ± 0.6

136.25 ± 0.44 136. 21 ± 0.42 136.6 ± 0.6

147.19 ± 0.46 146. 99 ±0.52 146.3 ± 0.6

157.78 ± 0. 50 157.65 ± 0.66 158.6 ± 0.6

a 95% confidence limits.

one decimal place since they are less numerous

results made in a single laboratory.

The accuracy of the round robin results is within

the recommended goal of the reference method.

There does not appear to be any significant bias

for either the manual or the semiautomated techniques over the range of sodium concentrations

studied

.

Auxiliary Statistical Analysis

The protocol requires a check on the flame emission

spectrometer by running a calibration curve each

day using freshly prepared standard solutions.

The necessity of these curves also provides a

check on the correct preparation of the standard

solutions. The data reported here on the calibration curve check are advisory in nature since in

the actual analytical procedure only the pair of

56
calibrating solutions nearest to the unknown

concentration is used. The calibration curve data

for the manual and semiautomated sodium procedures

were reported and are given in Tables 16-17.

Straight line least square fits were made to these

data and the resultant standard deviations of fit

are given in Table 18. These standard deviations

of fit are expressed in units of sodium concentration (mmol/L) . Our analysis indicates that if in

the calibration step it is found that any calibration point deviates from the calibration curve by

more than 1.0 mmol/L, then the standard solutions

and the instrument should be checked for sources

of excessive error before proceeding further into

the analysis.

j

57
Table 16. Calibration curve data for sodium in serum, Round Robin II

using manual pipetting.

Lab. No.

c

4-1

4- 2

5- 1

7-1

7- 2

8- 1

9- 1

9-2

11-1

11-2

13-1

15-1

15-2

Std. 1 Std. 2 Std. 3 Std. 4 Std. 5 Std. 6

Y

b

X 109

.

A o 98 1 1 A 119

.

n o 98 1 O A 129

.

n o 98 t 7 n 139

.

n o 98 t ^ n 149

.

9 /

i cn 159 . n *7 9 / Y

C 109. 70 119. 60 129. 80 140. 20 150. 10 160. 20

v

X

t a a 109

.

A O 98 1 1 A 119. A O 98 T 1 A 129

.

n o 98 i t n 139

.

n o 98 149

.

9/ t r n 159

.

n t 9/

Y 110. 10 120. 40 130. 60 140. 80 150. 60 160. 40

X

i i a 110

.

a a 00 T O A 120. A A 00 T 7 A 130

.

A A 00 1 /I A 140

.

A A 00 i r a 150. A A 00 T £ A 160

.

A A 00

Y 110. 60 120. 40 130. 40 140. 40 150. 90 160. 00

X

i a a 109. a a 69 120. O A 24 1 O A 129. 97 1 7 A 139

.

78 i r a 150

.

1 7 13 T £ A 160. A H 07

Y 110. 20 120. 20 130. 10 139. 50 149. 60 158. 90

X

t a a 109. d A 69 T O A 120. O A 24 1 O A 129. A "7 97 T *7 A 139. 78 t r a 150. 1 7 13

1 £ A 160. A *7 07

Y 110. 10 119. 90 130. 00 139. 20 149. 30 158. 50

V- ATin 110. a a 00 1 O A 120

.

A A 00 1 7 A 130

.

A A 00 1 A A 140. A A 00 i r a 150. A A 00 1 £ A 160

.

A A 00

Y 113. 60 122. 40 131. 70 141. 60 151. 00 160. 00

X 109

.

70 120

.

20 1 7 A 130. A A 00 140

.

7 A 30 1 r a 150

.

a n 40 i c n 160

.

1 A 10

Y 67. 60 73. 80 80. 60 87. 30 92. 80 98. 20

X

i a a 109

.

O A 80 T O A 120. A A 00 1 "7 A 130. T A 10 T /I A 140. 1 A 10 t r a 150. A A 00 T £ A 160

.

A A 00

Y 547. 00 600. 00 653. 00 704. 00 754. 00 795. 00

vXT 1 A 110. A A 00 1 O A 120. 15

"1 7 A 130. A A 04 140. A O 08 1 A A 149. A T 97 T £ A 160. A O 08

Y 107. 60 118. 30 129. 10 140. 00 150. 10 160. 20

X

i i a 110. A T 07 T O A 120

.

r~ 7 53 T 7 A 130. A £1 06 141

.

A 1 42 1 V A 150. 7 T 37 1 £ A 160

.

74

Y 108. 40 118. 60 128. 70 140. 20 149. 50 160. 40

X

1 1 A 110 1 O A 120 1 7 A 130 140 t r a 150 1 C A 160

Y

i i a 110 -ion 120 130 140 150 160

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 110. 28 118. 18 130. 02 139. 02 149. 24 157. 66

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 109. 08 118. 96 128. 52 137. 54 146. 74 156. 40

The laboratory designation consists of two parts : the initial

digit (s) represents the assigned laboratory number and the last

digit represents either the first or second day's results.

X = Standard solution values in mmol/L.

Y = Instrument reading.

58
Table 17. Calibration curve data for sodium in serum, Round Robin II

using semiautomated pipetting.

Lab. No.

a

1-1

1- 2

2- 1

2-2

4-1

4-2

9-1

9-2

10-1

10- 2

11- 1

11-2

15-1

15-2

The laboratory designation consists of two parts: the initial

digit (s) represents the assigned laboratory number and the last

digit represents either the first or second day's results.

X = Standard solution values in mmol/L.

m

Y = Instrument reading.

59

Std. 1 Std. 2 Std. 3 Std. 4 Std. 5 Std. 6

vb

x

c

110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 107. 70 118. 00 128. 40 138. 70 148. 40 160. 00

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 108. 00 118. 30 128. 70 139. 30 149. 10 160. 00

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 108. 90 119. 70 129. 70 140. 50 150. 50 159. 90

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 108. 50 118. 90 129. 10 139. 10 149. 10 159. 90

X 109. 98 119.9,8 129. 98 139. 98 149. 97 159. 97

Y 109. 10 119. 80 129. 80 139. 90 149. 90 159. 50

X 109. 98 119. 98 129. 98 139. 98 149. 97 159. 97

Y 109. 90 120. 10 130. 30 140. 60 149. 90 159. 80

X 109. 70 120. 20 130. 00 140. 30 150. 40 160. 10

Y 60. 80 65. 00 71. 10 77. 50 82. 00 87. 20

X 109. 80 120. 00 130. 10 140. 10 150. 00 160. 00

Y 465. 00 509. 00 551. 00 595. 00 637. 00 683. 00

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 109. 30 119. 60 130. 30 140. 30 150. 60 160. 60

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 108. 20 119. 00 129. 70 140. 20 150. 80 161. 00

X 111. 99 120. 24 130. 85 139. 98 150. 61 160. 21

Y 109. 20 117. 56 128. 20 138. 46 149. 16 159. 13

X 110. 18 120. 92 131. 87 141. 69 150. 11 160. 46

Y 109. 13 120. 40 131. 16 141. 50 149. 56 160. 26

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 111. 44 121. 90 131. 12 140. 76 150. 70 160. 00

X 110. 00 120. 00 130. 00 140. 00 150. 00 160. 00

Y 111. 62 122. 18 132. 16 141. 06 151. 04 160. 00
Table 18. Calibration curve results for sodium in serum as

standard deviation of fit (s^^) in mmol/L.

- Manual - - ory Number

- -

S fit

- - - Semiautomated

Laboratory Number

- - -

S fit

4-1 . 14 1-1 .43

4-2 . 23 1-2 .22

5-1 . 32 2-1 .45

' 7-1 .22 2-2 . 23

7-2 . 30 4-1 . 32

8-1 .33 4-2 . 33

9-1 .87 9-1 1. 24

9-2 . 79 9-2 .'. 2 8

11-1 .34 10-1 .21

11-2 . 23 10-2 .18

13-1 11-1 .27

15-1 . 96 11-2 .22

15-2 .29 15-1 .32

15-2 . 56

The laboratory designation consists of two parts: the

initial digit(s) represents the assigned laboratory

number and the last digit represents either the first

or second day's results.

60
V. DISCUSSION

A . Candidate Protocol :

1. Preliminary Tests

Generally, in the development of a reference method

where the state of analytical knowledge leaves an uncertainty

in the choice of a 'candidate' reference method, it is essential that investigations be undertaken to assure optimized

analytical conditions, minimized interferences, and freedom

from other sources of bias. Such preparation helps avoid

initiating the interlaboratory testing process with inappropriate procedures. However, in the case of sodium, the

similarity of results obtained by White and Mavrodineanu

using FAES and the similarity of their results with those

obtained using the highly specific IEG and NAA methods, led

the Committee to decide to proceed directly into the round

robin testing phase with the FAES method, without further

preliminary studies.

2. Specifications

In light of the prior experience [3,6,16], the written

protocol is explicit as to reagent and glassware specifications, pipetting, and directions for dilution of the standard

and sample. Thus, Class A or equivalent glassware, reagent

grade or equivalent chemicals, 'tested' water, analytical

balances with a ±0.1 mg weighing capability, and a pipettordilutor with tested accuracy and precision are specified.

In addition, the reference method provides for the use of

analytical techniques that should reduce the combined error

due to weighing, pipetting, and dilution to below one percent.

3. Flame Atomic Emission Spectroscopy

Specific instructions are not given for the use of

flame emission instruments. In general, all the instruments

61
used in the laboratories that participated in this studyprovided excellent results. The FAES instruments that were

used are listed in Table 19. Internal and non-internal

standard instruments for which nine laboratories used 200-

fold dilution and two laboratories used 100-fold dilutions

provided essentially similar results. One laboratory used

air-acetylene rather than air-propane as oxidant-fuel without

a problem. Thus specifications other than the requirement

for stable instrument operating conditions are not presented.

As in sample preparation and handling, the human element in

achieving accuracy and precision is critical. It is essential

that operators be thoroughly familiar with their instruments

and alert to the onset of instrumental difficulties.

The protocol initially required a one-percent agreement

for measurement sets to be considered valid. That requirement

was changed to two percent at the July 1975 meeting of the

representatives from the participating laboratories. In the

discussion that led to this protocol change, the representatives affirmed that if their instruments were operating

optimally, agreement of successive sets of readings could be

obtained to within 0.5 percent. However, the precision of

the round robin results was not significantly degraded due

to this change.

Instrument linearity requirements were not included in

the protocol since the bracketing method for obtaining valid

measurements was used to minimize the errors attributable to

instrumental drift. Nevertheless, on examination of the data

reported for the calibration curves, excellent linearity was

found over the range of sodium concentrations from 110 to 160

mmol/L. More than 80 percent of the calibration curves showed

standard deviations of fit of about 0.5 percent and the remainder about 1 percent. A standard deviation of fit larger than

1 percent would clearly warrant a laboratory's investigation

of its operation of the procedure and/or preparation of the

standard solutions.

62
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H

Con Cm

03 03 M c U 'rH CD W

PQ

to

to

to

PI

LO

CD Popp

03i •He0

CO

II <

CO 0

l—l03 •H

,P I U e CO

CO

ii 03

l—l CJ

n30PPo

Ph0ppoz

03 Pi

U

63
The use of the bracketing criterion for valid sets

determined that a 50-mL minimum volume of working sample

was needed for the semiautomated pipetting protocol. About

25 mL of the working solution is required to obtain five

sets of valid measurements, assuming a nebulization rate of

2-4 mL/min for approximately 45 s to obtain a single reading.

(That time - interval is necessary for the instrument and

flame to be stabilized and for actual integration of the

signal.) Much larger volumes of diluted sample were available with the manual pipetting protocol because of the large

aliquot volumes taken to ensure pipetting accuracy.

4. Statistical Analysis

All of the results discussed here are based on the

analysis of four replicate samples analyzed as pairs on two

separate days. Adherence to this pattern of replicate

analysis helped assure the reliable performance of the

reference method.

With the exclusion of results from one laboratory using

the manual procedure, the imprecision and bias goals of ±1.5

and 2.0 mmol/L, respectively set at the 140 mmol/L level,

were in fact reached over the total concentration range by

the laboratories using either the manual or semiautomated

pipetting protocols. Additionally, there were no significant

differences in either the imprecision or bias values obtained

by the two pipetting alternatives as evident in Table 14.

In fact, except for the imprecision of the semiautomated

procedure i° total

= 0.86 mmol/L) at the 158.6 mmol/L level,

all other imprecision and bias values are at least twice as

good as the original goals set for the reference method by

the Experts Committee. Thus for laboratories in the population typical of those participating in this study (i.e.,

clinical laboratories that have practiced the reference

method and are in good quality control) imprecisions i a total)

64
within ±0.75 mmol/L and biases within 1.0 mmol/L can be

expected in the performance of this reference method.

VI. CONCLUSIONS

A candidate reference method, specified by a written

protocol for the determination of serum sodium by flame

atomic emission spectroscopy was evaluated by comparing

results of analyses run on serum and aqueous samples in a

selected group of laboratories against definitive method

values obtained on samples from the same pools. The results

for samples having sodium concentrations in the 110 to 160

mmol/L range showed a total imprecision of approximately

0.75 mmol/L or less and a maximum bias of 1.0 mmol/L.

Similar imprecisions and biases were found whether manual

pipetting, requiring large sample volumes, or semiautomated

pipetting, requiring small sample volumes, was used in the

FAES procedure. An ion-exchange separation of sodium from

the serum samples followed by its conversion into sodium

sulfate for determination by gravimetry was used as the

definitive method.

Statistical analysis of the results shows that the FAES

method can be carried out with the accuracy and precision

expected of a reference method for serum sodium. Hence, the

candidate method can be considered to be the reference

method. This reference method may be used to establish the

accuracy of field methods for sodium by comparative testing.

It may also be used to determine reference serum sodium

values. Each of these uses would require an appropriate

experimental design to ensure achievement of the desired

accuracy and precision goals.

65
We would like to especially thank the principal

investigators and other scientists in the participating

laboratories listed in Appendix A, who, through their

efforts, made this work meaningful and possible. We thank

Dr. David Bayse and Ms. D. Sue Lewis, CDC, for providing

excellent, homogeneous serum pools used in the interlaboratory testing process.

The work at NBS was carried out in the Institute for

Materials Research and we acknowledge Ms. Nancy Steele for

initial reduction of the PRR and PRI data. We thank

Dr. Philip D. LaFleur, Chief, Center for Analytical Chemistry,

and Mr. J. Paul Cali, Chief, Office of Standard Reference

Materials, for their support and encouragement throughout

this program. Special thanks go to Dr. Radu Mavrodineanu

,

Mr. Theodore Rains, and Dr. Michael Epstein for discussions

and suggestions in the area of flame atomic emission spectroscopy. Acknowledgement is also made to Mr. John Matwey and

Mr. Carl Barry for help in sample handling. Special thanks

are due to Mrs. Joy Shoemaker of the Text Editing Facility

for her efforts in manuscript production which included

formatting, editing, and typing.

The Bureau of Medical Devices of The Food and Drug

Administration is acknowledged for their financial support

of this project.

66
VII. REFERENCES

[1] Henry, R. J., Clinical Chemistry: Principles and

Technics, 1st Edition, Harper and Row, Publishers,

New York, N.Y. 1964, p. 345; Weissman, N. and Pileggi,

V. J. in Clinical Chemistry: Principles and Technics,

Henry, R. J., Cannon, D. C. , and Winkelman, J. W.

,

Eds., 2nd Edition, Harper and Row Publishers, New York,

N.Y. 1974, p. 641.

[2] Benotti, J. in "Standard Methods of Clinical Chemistry"

Vol. I, M. Reiner, Ed. Academic Press, New York, N.Y.

1953, p. 102; Hold, P. M. and Mason, W. B. in "Standard

Methods of Clinical Chemistry", Vol. II, D. Seligson,

Ed., Academic Press, New York, N.Y. 1958, p. 165.

[3] Cali, J. P., Mandel, J., Moore, L. J., and Young, D. S.

"A Referee Method for the Determination of Calcium in

Serum" Nat. Bur. Stand. (U.S.) Special Publication

260-36 (1972). For sale by: Superintendent of

Documents, U.S. Government Printing Office, Washington,

D.C. 20402 SD Cat. No. C13 . 10 : 260 - 36

[4] Pybus , J., Feldman, F. J., and Bowers, G. N. Jr., Clin.

Chem., 16, 998 (1970).

[5] Moore, L. J., in Reference 3, page 63.

[6] Cali, J. P., Bowers, G. N. , and Young, D. S., Clin.

Chem. , 19 (10) , 1208 (1973)

[7] Available from: Office of Standard Reference Materials

National Bureau of Standards, Washington, D. C. 20234.

[8] Serum samples have been stored frozen for several years

at temperatures below -20 °C with no apparent affect on

electrolyte concentration. White, J. CDC, Private

Communicat ion

67
[9] Thawed serum samples were mailed to the participating

laboratories. In previous experiences at CDC, thawed

samples mailed to the west coast and returned after two

weeks showed no change in serum electrolyte concentration. White, J., CDC, Private Communication.

[10] Reagent Chemicals, American Chemical Society Specifications ACS Publications, Washington, D.C. (1968).

[11] Hughes, J. C, "Testing of Glass Volumetric Apparatus,"

NBS Circular 602, 1959. For sale by: The Superintendent of Documents, U.S. Government Printing Office,

Washington, D.C. 20025.

[12] In retrospect, data from Laboratory 15 for the manual

and semiautoma ted pipetting procedures for RRII should

not have been introduced into the statistical analysis

of data. The manual procedure data was not included

and the inclusion of their data for the semiautomated

procedure had little effect on the statistical results

since they were very similar to the data from the other

laboratories

.

[13] Mandel, J., "Models, Transformations of Scale, and

Weighting", Journal of Quality Technology, Vol. 8,

No. 2 , 86-97 (1976)

.

[14] Mandel, J., "The Inter laboratory Evaluation of Testing

Methods", ASTM Bulletin 239, 53-61 and 133 (1959).

[15] Mandel, J., "Estimation of Weighting Factors in Linear

Regression and Analysis of Variance", Technometrics

,

6, 1-25 (1964)

.

[16] Clinical reference methods are also being developed at

NBS for potassium, lithium, chloride, and magnesium.

68
APPENDIX A

Scientists not previously acknowledged who contributed to

this study are:

Dr. Robert Moore

Hartford Hospital

Mrs. Harriet Bailey

Dr. Daniel Grisley

New England Deaconess Hospital

Dr. Johan Kofstad

University of Oslo

Mr. Orlando Flores

Mr. James North

Beckman Instruments

Mr. David Hassemer

Mr. Richard Schlough

University of Wisconsin

Miss Mary Dassow

Mrs. Shirley Wertlake

University of California

Mr. Frank Doherty

Pennsylvania Department of Health

Mr. Claude Walker

Food and Drug Administration

69
U. S. Department of Commerce

Frederick B. Dent

Secretary

APPENDIX B

National Bureau of Standards

Richard W. Roberts, Director

Rational ^ttram of Standards

Certificate of (Analysis

Standard Reference Material 919

Sodium Chloride

(Clinical Standard)

This Standard Reference Material is certified as a chemical of known purity. It is intended

primarily for use in the calibration and standardization of procedures emploved in the determination of sodium and chloride ions in clinical analyses. The sample consists of highly purified sodium

chloride. Chemical assay as well as analyses for specific impurities indicate that the material may be

considered essentially pure, except for occluded moisture.

Purity 99.9 ± 0.0 percent

The above value for the purity of the material is based on a sample dried over magnesium

perchlorate for 24 hours. At room temperature sodium chloride is hygroscopic above 60 percent

relative humidity. The sorbed water can he removed, however, by desiccation over freshly exposed

P2O5 or Mg(CIC>4.)2 for 24 hours. Chloride was determined using the eoulomelrie method of

Marinenko and Taylor [J. Res. NBS, 67A, 31(1963)].

Based on 8 independent measurements of chloride content, the sample is considered homogeneous.

When the material is crushed and dried at 200 °C for 18 hours, the loss of moisture is about

0.08 percent. Couiometric determinations of chloride on the dried material indicate 99.995 ± 0.004

percent purity.

The sodium chloride used for this Standard Reference Material was obtained from the J. T. Baker Chemical Company, of Phillipshurg, New Jersey. Analyses were performed by G. Marinenko,

J. R. Baldwin, M. Darr, and T. C. Rains.

The overall direction and coordination of technical measurements leading to the certification were under the chairmanship of R. A. Durst.

The technical and support aspects concerning the preparation, certification, and issuance of this Standard Reference Material were coordinated through the Office of Standard Reference Materials

by T. W. Mears.

Washington, I). C. 20234

August 6. 1973

Revised November 23, 1973

J. Paul Cali, Chief

Office of Standard Reference Materials

(over)

70
Supplemental Information

This material was examined for compliance with the specifications for reagent grade sodium

chloride as given in Reagent Chemicals, 4th edition, published by the American Chemical Society.

The material meets or exceeds the minimum requirements in every respect.

Sodium was assayed using a gravimetric procedure in which the sodium chloride was converted

to sodium sulfate. Approximately 250 mg of sodium chloride (dried at 500 °C for 4 hours in a platinum crucible) was dissolved in ultrapure sulfuric acid solution (1:1) and evaporated to dryness.

Ammonium carbonate was added and the crucible slowly heated to 600 °C, then 900 °. This

treatment was repeated until the weight of sodium sulfate remained constant. Based on 6 determinations, the sodium assay is 39.

3

2 weight percent or 99.

9

6 percent of the amount computed for

perfectly pure, stoichiometric NaCl.

A semiquantitative survey for trace elements by emission spectroscopy indicated less than 10

jug/g calcium, copper, iron, and magnesium. A value of less than 3 Mg/g magnesium was obtained by

atomic absorption spectrometry. Flame emission spectrometry indicated the presence of the following elements: potassium, 11 /ig/g; calcium and cesium, less than 2 jig/g; and rubidium and lithium

less than 0.5 A<g/g71
APPENDIX C

I DEFINITIVE METHOD

The Determination of Serum Sodium by Ion Exchange - Gravimetry

' (IEG) I

I . Introduction

One of the classical analytical techniques for the

determination of sodium is gravimetry as sodium sulfate [l] 1

. The major difficulty in this procedure is obtaining a precipitate of constant weight. This is usually due to the formation of sodium bisulfate which is difficult to decompose into

sodium sulfate. Lundell and Hoffman suggest treating the

weighed original residue with water, and then evaporating,

igniting, and reweighing until constant weight is obtained.

Below 700 °C, there is no loss of sodium sulfate due to

volatilization of the precipitate. This procedure was adapted

for the determination of sodium in serum by the application of

ion-exchange chromatography as a quantitative scheme for

separating the sodium from serum. The method which follows

describes the details of the sodium determination using a

chromatographic separation of sodium from serum and its

subsequent conversion into sodium sulfate.

To minimize sampling errors, the serum samples were taken

by weight. Results were converted from a weight/weight to a

r weight /vo lume basis by measuring the density of three serum

pools, using a pycnometer. The density of the remaining serum

pools were determined by interpolation, Table 1. Following

previous practice at this laboratory, all density measurements

are corrected to 23 °C which is approximately the mean laboratory temperature. Concentration values reported, therefore,

are also at 23 °C.

figures 1 and 2 in brackets denote references at the end

of this appendix.

72
The ion-exchange chromatography is fairly routine but

some precautions should be observed. The columns should be

prepared by adding a slurry of resin and water to a column

; largely filled with water, so that relatively few air bubbles

are entrained. If a column is stored overnight, it should be

tightly capped with clean polyethylene film to prevent drying.

The sample should be added to the column in small increments;

all of the initial increment should enter the resin bed

I before adding more sample increments.

With some samples, the serum may be deproteinized by the

I hydrogen ions that are released during the exchange of sample

j cations. In severe cases, the column flow-rate will be

| restricted enough to warrant using a Teflon stirring rod to

- break up the cake of material at the top of the column.

Other than slowing the rate of elution, the deproteinization

! does not effect the separation of sodium. After the column

has been washed with water to remove the non-absorbed components of serum, the cations are eluted with 0.4 mol/L HC1.

The normal order of elution with this reagent is Li

+

, Na

+

, K

+

, Mg

++

, and Ca

++

. Fortunately, there is usually little

Li in serum so that the separation of sodium from lithium is

ordinarily easy. For sera with elevated Li values, the separation may not be complete; however, analyses of the Li and

Na fractions by FAAS and FAES permit appropriate corrections

to be made. In eluting with the 0.4 mol/L HC1, it is important

to add small increments of the reagent without disturbing

the resin bed, allowing each addition to enter the resin bed

; before adding the next. Failure to observe these precautions

may produce band-broadening and complicate the separation of

| sodium from potassium. Because the amount of resin in each

column and the efficiency of the chromatography may vary

slightly, it is very important to use a flame test to judge

when to collect the various fractions. Usually it is only

the sodium/potassium separation that poses a problem and, if

it is suspected that poor separation has occurred, the

73
post-sodium fraction can be examined by FAES to determine the

presence of sodium and suitable corrections then can be made.

Similarly, after the sample has been ignited and weighed as

sodium sulfate, the sodium fraction can be checked for contamination by FAES (K, Li) or FAAS (Ca, Mg , Li, etc.) For

the analyses reported here, corrections were negligible.

Most of the impurities that were observed are believed to

have come from the platinum crucible used for the ignition.

A reddish-brown to black discoloration of the sodium sulfate,

observed after ignition, may be attributed to small amounts

of dissolved platinum.

The platinum crucibles were cleaned and ignited at

900 °C to constant weight before they were used in this

procedure. Because of the relatively large mass of the

crucible Ol5 g) compared to the NaaSCU O50 mg) weighing

errors following the ignition can be the most troublesome

part of the analysis. To improve weighing accuracy, several

empty platinum crucibles were used as weighing tares to

correct for changes in temperature, barometric pressure, and

relative humidity which caused day-to-day variations in the

weights of the empty crucibles. By correcting for such day

to day changes, it was possible to determine the weights of

the ignited samples more accurately. When sucessive ignition:

yielded only a loss of approximately 10 ug, a sample was

considered to be at constant weight. Some slight loss of

mass will occur during each ignition, therefore the number

and duration of sample ignitions should be kept to a minimum.

Crucibles containing samples, standards, blanks, and tares

should be ignited, cooled, and weighed in sets so that corrections or losses will be reflected to the same degree in

all samples. A loss of more than 20 yg between ignitions

was taken as evidence that the sample had not yet been

ignited to constant weight. Usually, two ignitions are

sufficient to achieve constant weight. Crucibles were left

7 4
only partially uncovered during the ignition to reduce the

potential for loss of precipitate.

II. Samples and Solutions

A. Samples : Three samples from each of the seven

serum pools, two blanks and seven standards were analyzed by

the procedure summarized in Section III.

B. Reagents : All acids and water used were purified

by a sub-boiling distillation technique, from quartz

stills [2].

C. Sodium Standard Solutions : Standard sodium solutions were prepared from NaCl (SRM 919) and KC1 (SRM 918).

The concentrations of sodium and potassium were equivalent

to those in normal serum.

D. Chromatographic Columns : Fifteen ion-exchange

chromatographic columns were prepared (AG 50X8 resin, 100-

200 mesh, 0.9x30 cm) and pretreated by washing with 100 mL

of 5 mol/L HC1, followed by rinsing with water until the

effluent was neutral. [Note: The samples, blanks, and

standards were divided into two groups for analysis at

different times since a maximum of only 15 columns could be

handled efficiently by one person.]

E. Blanks : Water was used as the blank.

III. Procedure

Weighed samples of serum (>8 g) were taken as follows:

The frozen serum samples were allowed to thaw and equilibrate

to room temperature. Each serum sample was mixed during

this time by inverting the vials at least 20 times. Then, a

sample was drawn from a vial into a clean plastic syringe

through a platinum needle and the syringe containing the

serum was weighed on a semi -microbalance . After the serum

75
was discharged into a clean Teflon beaker, the emptied

syringe was re-weighed. A clean syringe and needle combination was used for each sample.

Each weighed sample was diluted to ^30 mL and loaded

onto a separate column a few milliliters at a time. About

100 mL of distilled water was used to wash non-ionic matter

from each column. The effluent from each column was monitored

qualitatively by a flame test for sodium. The sodium fraction

did not elute exactly between 105 and 260 mL, as described

below; however, the exact volumes for fractionating were

easily recognized by the flame test. [NOTE: For normal

serum, any error due to Li contributing to the Na fraction

will be insignificant if the first cut at about 105 mL is

made when the first positive flame test for sodium is obtained.

The fraction at about 260 mL is determined when the yellow

flame test for sodium is barely detectable but before the

flame test for potassium is evident when viewed through a

, cobalt-blue glass. A record of flame test results indicates

whether any of the eluted fractions need to be checked by

FAES or FAAS to determine appropriate corrections.]

The elution was begun with 0.4 mol/L HC1. Small volumes

(<5 mL) were added. Each was allowed to pass into the column

before adding the next volume of acid. The first 75 mL of

effluent was discarded. The 75-105 mL fraction, the 105-260

mL fraction containing the sodium, and the 260-300 mL fraction

containing potassium were saved. If the flame tests gave a

positive sodium indication with the 75-105 mL and/or the

260-300 mL fractions, FAES was used to determine the amounts

of sodium present in these fractions. The fraction containing

the sodium eluted from each column was evaporated to about

5-10 mL in a Teflon beaker on a hot plate. The concentrated

samples were transferred quantitatively from the beakers to

previously ignited and weighed platinum crucibles. Small

volumes of water were used to complete the transfer. The

samples were then evaporated to dryness on the hot plate.

76
When cool, the crucible walls were treated with water

to wash residues to the bottoms of the crucibles. Then a

few drops of concentrated H 2 SCU were added and the samples

were heated to dryness. When the samples were again cool,

the procedure was repeated. Finally, a lump of ammonium

carbonate (^0.5 g) was added to each crucible and the crucibles were partly covered with platinum covers. [NOTE: The

ammonium carbonate helps prevent the formation of sodium

bisulfate.] The crucibles were heated slowly in a muffle

furnace Ol . 5 h) to 900 °C, and held at that temperature for

15-20 minutes. After the furnace had cooled sufficiently to

permit retrieval with asbestos gloves and platinum tongs, the

crucibles were transferred to a desiccator to cool overnight.

The crucibles were weighed the next day. Then a few drops

of water were added to each residue, the water was evaporated,

and the samples were again ignited, stored in the desiccator,

and weighed. This process was continued until constant

weight was achieved. Ignite samples no more than necessary.

Carry all blanks and standards through the same procedure.

IV. Results

The sodium concentrations and the densities determined

for the seven serum pools are summarized in Table 1.

V. Analysis of Estimated Errors

A. Samples : The total uncertainty in sampling by

weight (^8 mL serum, weighing by difference) is ±0.004

percent. The uncertainty in the density determinations are

approximately ±0.02 percent. Under the worst conditions the

maximum error due to sampling and density determinations

would be ±0.05 percent.

77
Table 1. Sodium concentrations and densities determined for

the seven serum pools.

Serum

Density

g/mL

1.0248

Sodium Concentration in Serum

Replicates, mmol/L Average, mmol/L

113.98

112. 72

112.91

113. 2± 0. 6'

1.0255 120.47

120.95

121 . 54

121.0±0.6'

1.0262 129.91

129.70

130. 04

129.9±0.6'

1 .0269 136. 15

137.15

136.42

136.6±0.6'

1 . 0276' 145.62

146.14

147 . 20

146.3±0.6'

6 1 . 0283' 153. 70

153 . 92

153.90

153. 8±0. 6'

1. 0290 158 . 29

158.46

158 . 95

158.6±0.6'

95% confidence limit for the mean of the serum pool. (A

pooled estimate of the standard deviation was used for

this limit .

)

Extrapolated value of density.

78
B. Chromatography : The major source of error is

>r i incomplete resolution of sodium. This could result in

I partially compensating errors through loss of sodium to

' other elemental fractions and contamination of the sodium

fraction. Considering these factors and actual analysis for

, sodium, lithium, potassium, calcium, and magnesium in suspect

| fractions as shown by the FAES and FAAS tests, the maximum

error could be as much as ±0.2 percent.

C. Weigh i ng and Ignition : Errors due to day-to-day

weighing imprecision (caused by changes in humidity, barometric pressure, tares) and to the ignition process (volatilization of precipitate, etc.) could approach ±0.2 percent.

D. Recovery of Standards : The quantitative recovery

; of standards averaged 99.91 percent of theoretical with a

standard deviation of ±0.15 percent. The estimated maximum

| error is thus ^±0.2 percent.

E. Other Sources : Error due to non-quantitative

solution transfer, spills, spatter, etc. are estimated at

0.2 percent

F. Total Estimated Error : In the worst case, the

values estimated for the various sources of error, as listed

in Table 2, would be added to give a value for the total

estimated error of 0.75 percent, which corresponds to 1.05

mmol/L at the 140 mmol/L sodium level. This estimated error

is consistent with the experimentally observed random error.

79
Table 2. Estimated systematic errors in the various

steps for the determination of sodium in

serum by ion exchange separation followed

by gravimetric determination as sodium

sulfate

.

Source Magnitude, %

1. Sampling 0.05

2. Chromatography 0.20

3 . Ignition 0 . 20

4. Recovery of Standards 0.20

5. Other 0.10

Total 0.75

VI. References

1. Lundell, G. C. F. and Hoffman, J. I., in "Outline of

Methods of Chemical Analysis", John Wiley and Sons,

New York, 1938, p. 105.

2. Kuehner, E. C. , Alvarez, R. , Paulsen, P. J., and

Murphy, T. J., Anal. Chem., 44, 2050 (1972).

80
U.S. DEPARTMENT OF COMMERCE

NATIONAL BUREAU OF STANDARDS

WASHINGTON. D.C. 20234

Supplementary Neutron Activation Analysis of Serum Pools

REPORT OF ANALYSIS

Type of Analysis: Neutron Activation, Nondestructive

Irradiation Facility: Californium- 2 5 2 Facility

Element Reported: Na

Analysts: James E. Suddueth, Russell M. Morris, and

Harry L. Rook

Purpose : To ascertain the Na concentration in bovine blood

serum within a relative standard deviation of ± 1.0% or

better

Sample Preparation : Samples, as received, were thawed overnig]nt and thoroughly mixed by gentle shaking and tumbling

for a minimum of 5 minutes. The thorough mixing was carried

out to negate the demonstrated stratification of sodium in

the serum caused by freezing and thawing. Three ml of each

sample and each standard was pipetted into a cleaned polyethylene rabbit. All rabbits were sealed with Carter's

rubber cement.

Standards : Three concentrations of standard solutions were

prepared by dissolving NBS Standard Reference Material 919,

Sodium Chloride (clinical standard), in high purity water.

Five samples were taken from a solution containing 2708 yg

Na/g H2O, two from a solution containing 3401 yg Na/g H 2 0,

and four from a solution containing 2966 yg Na/g H 2 0. Before

starting the analysis of the serum, a set containing each of

the three standards was irradiated for 2-1/2 hours and

counted for 2 hours. After decay, corrections and calculations were made; the relative percent standard deviation

among the set was 0.2 percent.

Blanks : Two blanks were run with the same procedure as any

other standard or sample except they contained high purity

water. The counts from background were subtracted from the

counts from the blanks. The total blank was less than

2 yg Na/g.

Procedure : Samples and standards were individually irradiated

in the Cal if ornium- 2 5 2 facility for 2-1/2 hours at a source

distance of 3 cm. After irradiation, the outside of each

capsule was cleaned with cone. HN0 3 , rinsed, and wiped dry.

81
All samples were allowed to decay at least 12-1/2 hours to

allow chlorine and argon (if present) to completely decay.

The samples were counted 2 hours each in a Nal(Tl) well

detector. The maximum decay variations between samples was

112 min and individual corrections were made.

The counting system consisted of the detector, preamp, amplifier, two single channel analyzers, two scalers and a

timer. One SCA was set to integrate the 1.368 MeV peak area

and the other to integrate the 2.75 MeV peak area. Each SCA

was fed to a separate scaler. This allowed a ratio check to

be made on the two peak areas to determine if any interferences were present. A sodium citrate sample was run initially

to obtain a ratio with only Na present in the sample. One

sample was counted on a 25 cc Ge(Li) detector and no interferences to the two 21+ Na photo-peaks were observed.

Calculation : The two peak's activities were corrected to

each separate daily run, added together and the average blank

and background activity were subtracted.

The results were calculated by the comparator method. The

standard activity used was obtained from a pooled set of all

standards data obtained during the analytical period.

Errors : The estimate of analytical error was obtained by the

s tandard deviation among the 14 standards. The standard

deviation of the mean was .76% relative. This is a valid

estimate on the error of the total analytical system.

Results : Precision for all lots was .5% relative standard

deviation or better. The results are shown in Tables I and

II. Table III gives the average results for each lot, corrected for density, as millimoles per liter.

.James E. Suddueth Russell M. Morris

Engineering Technician Physical Science Aid

Activation Analysis Section Activation Analysis Section

Analytical Chemistry Division Analytical Chemistry Division

Chief (Acting)

Activation Analysis Section

Analytical Chemistry Division

82
Table I

Standard No. Counts/yg Na 2 hr.

* 1 134.38

* 2 131.72

* 3 134.08

1 135.15

2 135.58

3 134.57

1 134.53

1 133.46

1 134.54

3 133.23

1 134.88

3 134.75

2 132.94

3 133.34

u 134.08 Mean

Relative Standard Deviation: 0.76%

^Standards used to check calculated concentrations

83
Table II

Sample Result Mean Relative Standard

Lot Sample No. yg/g yg/g Deviation

1 258243 2576

1 223776 2553 2562 .5%

1 223776 2556

2 253001 2738

2 253001 2724 2728 .3%

2 53408 2721

3 663097 2935

3 663097 2932 2928 . 1%

3 223696 2917

4 531706 3078

4 531706 3085 3077 . 3%

4 632506 3069

5

" 291349 3316

5 291349 3328 3324 .2%

5 729874 3327

6 432826 3445

6 432826 3467 3459 .4%

6 30284 3465

7 313203 3530

7 313203 3552 3546 .4%

7 244982 3555

84
Table III

Lot [Na

+

] , mmol/L

1 114.2

2 121.7

3 130.7

4 137.4

5 148.6

6 154.7

7 158.7

85
APPENDIX D

Note 1:

A temperature range of room ±2 °C is designated as the

operating temperature. In this temperature range the maximum

difference in aqueous solution volumes due to thermal

expansion of the liquid is 0.102 percent. The difference in

volume due to the volumetric glassware is very small since

the coefficient of expansion for borosilicate glass is

0.00001 per °C. (J. Lembeck, "Calibration of Small Volumetric Laboratory Glassware", NBSIR Report 74-461, 1974,

Institute for Basic Standards, National Bureau of Standards,

Washington, D. C. 20234). We judge these errors to be

acceptable for this reference method. Larger temperature

changes may necessitate appropriate correction.

Note 2 :

Glassware Required:

a) Manual pipetting alternative:

Volumetric Flasks : (for one hundred-fold dilutions):

one 2-L; one 1-L; six 100-mL; seven 500-mL plus one

additional 500-mL volumetric flask for each sample.

Volumetric Flasks : (for two hundred-fold dilutions):

one 2-L; six 100-mL; eight 1-L plus one additional 1-L

volumetric flask for each sample.

Pipets : one 5-mL.

b) Semiautomated pipetting alternative:

Volumetric Flasks : (for one hundred-fold or two

hundred-fold dilutions): One 2-L; one 1-L; six 100-mL;

and seven 50-mL plus one 50-mL volumetric flask for

each sample.

86
Note 3:

Cleaning of glassware and the pipettor-dilutor

a) Clean the glassware in the following manner:

(1) Soak glassware for 60 min in 0.77 mol/L HN0 3 .

(2) Rinse six times with a volume of water equal to at

least 10 percent of the container volume.

(3) Use immediately or air dry (inverted in a dustfree environment) for later use.

b) Clean the pipettor-dilutor device as follows:

(1) Rinse the tubing with water by delivering at least

four 5-mL water samples.

(2) Rinse the tubing with 0.77 mol/L HN0 3 by drawing

into the delivery tube a volume of HN0 3 equal to

the volume of sample pipetted and then delivering

four 5-mL portions of HN0 3 through the system.

(3) Repeat step (2) using H2C1 , ethanol, and H2O

sequentially.

(4) Repeat step (2) with the diluent to be used for

preparing the working solutions of the sample,

standards, and blank. The pipettor-dilutor is

then ready for the preparation of the working

solutions

Note 4:

Procedure for Testing Pipettor-Dilutor Device : The accuracy

and precision of the device is determined by weighing fixed

volumes of water repetitively delivered by the device.

1. The water is delivered into tared, stoppered flasks that

are weighed on an analytical balance capable of being

read to the nearest one-tenth milligram. Measure the

temperature of the delivered water to the nearest 0.1

°C just before or after delivery.

87
2. Test the 0.250 mL or 0.500 mL delivery volumes as follows1

a. (1) Number and tare ten, clean, dry, stoppered,

glass or plastic weighing bottles of approximately

10-20 mL volume.

(2) Sample 0.250 or 0.500 mL of water and deliver

it together with 5 mL of diluent water into the

first bottle. Stopper immediately.

(3) Repeat step '2' with the remaining 9 bottles.

(4) Weigh each of the ten filled bottles.

(5) Calculate the weight of each aliquot (water)

plus diluent.

b. Repeat steps 1-5 of part a, but in step 2 omit

the sampling of the 0.250 or 0.500 mL of water by

allowing air to be sampled rather than water; thus

only the 5 mL of diluent water is collected in the

tared bottles. Calculation then gives the weights

of diluent.

c. Calculate from part b the mean weight for the

diluent

.

d. Calculate the differences between the individual

weighings obtained in part a step (5) and the

mean weight of the diluent (from part c) to obtain

the weights of water aliquots delivered at the

0.250-mL or 0.500-mL setting that was used.

e. Calculate the mean and standard deviation for the

weights of water aliquots delivered (from part d)

f. Use the attached table (#43) from Circular #19,

"Standard Density and Volume Tables," [National

Bureau of Standards, Washington, D.C. 20234] to

convert the mean of the diluent weights (from part

c) and the mean of the sample weights (from part e)

into volumes at 20 °C, in the following manner:

88
cr> r~- to

o oo r-. 00 cr t—

oo to CT> i—

to so oo cr> i—

to LO OO

o cxi LO i>-

(XI (XI cxi CXI cxi cxi to to tO to «!* =3- o

l>- i—i i-H OO \o lo is. cn (X) I—

rH to rH to LO

o (XI LO

cxi (XI (XI (NI (XI (XI to to to to «3- "3- o O O "3- to ^1- CT> to OO

i-H to i-H to LO CTi (X] i>- (XI (XI (XI (XI (XI (XI to to to to to o

m

CDCD

t-t 00

CD mo

in

+-> c

<x> H

LO OO to 00 LO to (XI rH CXI r> rH rH 1 I—

CXI LO CTi rH to LO CTi (XI 1 (XJ CXI (XI (XI CXI CXI to to to to to O

to I—r» to rH

o CTio CXI LO OO to CT ,1 I—

CXl LO CTi rH (XI LO CTi rH VO 1 LO CN] CXI Ox] CXI cxi CNJ r* )

to r* to to ^* "vf"

o

(XI LO

o LO CXI CTi OO COo CXIo ,1 i-H (XI LO r-- 00 o CXI t-- CT rH \o 1 CXI cxi CXI cxi f 

f J f ) ; ^3" o

rH OO to

o l>- vO LO OOO -=fr OO to

t—

cxi to LO oo

O (X] CT rH to

to (XI (Xl (XI CXI (XI (X] to to to to to oo to CXI OO LO to LO OO rH rH

rH (XJ to LO 00

o (XJ 00 rH to vO oo

(XI (XI CXI (XI CXI CXI CXI to to to to to 'd- O

OO rH LO

o \o ^t- CXI rH CXI to vO CTi to OO

o (XI to LO 00o (XI OO

O to LO OO

i-H (XI (XI (XI cxi (Xl CXI to to to to to •3" o

l>~o cn LO (XI

oo rH to rH (X]

o (X] to OOo rH OO

O to LO OO

O (XI (XI (XJ cxi (X) (X] to to to to to o I

?H -H (A

<D CD Ph CD CO g H U

CD

P

CD

T3!

LO OO CTt

o

CXI (Xl

CXI

cxi toCXI cxi LO

(XI CXI (XI OO

CXI (XI

89
1) Determine the volume of the nominally 0.250-mL

sample at 20 °C by adding to the mean value of the

delivered sample (from part e) , an amount equal

to the product of 0.0025 and the value for the

appropriate water temperature read from Table 43.

2) Determine the volume of the nominally 0.500-mL

sample at 20 °C by adding to the mean value of the

delivered sample (from part e) , an amount equal to

the product of 0.0050 and the value for the

appropriate water temperature read from Table 43.

The sums obtained are in milliliters.

3. The requirements for the bias and imprecision of the

p ipe t tor - di lutor are listed in Table 1. The pipettordilutor may be used in the semiautomated pipetting

alternative if these requirements are fulfilled.

Table 1. Bias and imprecision requirements for the volume

of sample delivered by the pipettor - di lutor

device, Section III-A2.

Imprecision, Relative

Sample Size, mL Bias, mL Standard Deviation

0.250 ±0.005 0.2%

0.500 ±0.010 0.21

Note 5:

The use of SRM Li 2 C0 3 is not recommended for this purpose.

However, if it is used, note the following:

a) The Li 2 C0 3 in NBS SRM 924 has been depleted in the 6 Li

isotope. Thus the atomic weight of lithium in this SRM

is 6.9696 rather than the usual 6.941, and the molecular

weight of this Li 2 C0 3 is 73.9484 rather than 73.8912.

Thus, more of the SRM 924 Li 2 C0 3 is needed to obtain the

lithium diluent solution with the desired concentration.

90
b) The atomic weights used in this report are those reported

in: Pure and Applied Chemistry, 47, 75 (1976).

Note 6:

There can be two blanks for the standards. The LiCl

diluent (or water) blank is nebulized to set the instrument

reading to zero. If the reading of this blank is not zero,

then its value and the blank for the working solution of the

KC1 diluent are to be subtracted from the readings for the

standards. Additionally, if the LiCl blank reading is not

zero, then its value must also be subtracted from the readings

obtained for the working samples.

Note 7:

If the wash solution does not drain cleanly from the

pipet, wash with 0.77 mol/L HN0 3 , H 2 0, Me OH , 70:30 v/v

CHCl 3 :MeOH, Me OH , and H 2 0 in that order. Then repeat the

water wash and check that the pipet does drain properly.

Note 8:

The three following pages are examples of the data

sheets returned from each laboratory after completing a

round robin test.

91
ELECTROLYTES IN SERUM CLINICAL REFERENCE METHOD

ION Na

LABORATORY ANALYST TN/JK

EXERCISE NO. RRI

1

DATE SAMPLES RECEIVED 12/10/75 DATES ANALYZED CD 1/13/76 (2) 1/16/76

INSTRUMENT MANUFACTURER

WAVELENGTH 589

IL MODEL 343

NM SCAN

SLIT WIDTH uM

BURNER TYPE Glass Chimney, Premix Design

SIT ON PEAK MAX

OXIDANT Air

FUEL Propane

FLOW RATE 0 ' 5 St ' F6Gt L/MIN 30 Psi§

FLOW RATE L/MIN 25 Psi§

INSTRUMENT TIME CONSTANT

RECORDER TIME CONSTANT _

READOUT: RECORDER

30-50

S

s

LABORATORY TEMPERATURE 18 °C TO

DIGITAL

22

X OTHER

°C (VARIATION DURING

ROUND ROBIN)

COMMENTS: 1. The results were achieved after optimizing the

instrument by the adjustments proposed in the maintenance manual

2. The linearity of the detector is still not

satisfactory, but we are working on the problem

92
DATA REPORTING SHEET FOR VALID MEASUREMENTS

LAB

PROTOCOL USED: MANUAL

8 ION R(

SEMI-AUTOMATED

SAMPLE tt 943277

STANDARD

CONCENTRATIONS

MMOL/L (CALCULATED)

L0 140.0

HI 150.0 (c

2

)

SAMPLE # 121276

STANDARD

CONCENTRATIONS

MMOL/L (CALCULATED)

110.0

LO

HI 120.0

(c

x )

(c

2

)

SAMPLE # 331174X

STANDARD

CONCENTRAT IONS

MMOL/L (CALCULATED)

L0 150.0

HI 160.0 (c

2

)

JD ROBIN 1 DATE ANALYZED 1/13/767 u n. ,- „ « TMr, OPERATOR TN

RELAT IVE INTENSITIES

VALID LO STD SAMPLE HI STD C

SET (x

2 ) (Y) (x

2

)

1 . 14 o . j 14 8.9 151.2 147 .1

2 . 143.1 148 .6 151.3 146 7

3 . 143 . 0 148 . 7 151.4 146 . 8

4. 143.0 148 .9 151 . 5 146 . 9

5 . 142 .9 148 .9 151 .4 147 . 1

RELATIVE INTENSITIES

VALID LO STD SAMPLE HI STD c SET Cx.) (Y) (x

2

)

1 . 114 . 8 118.0 123.6 113 . 6

2 . 114.6 118 .0 123 . 8 113 . 7

3 . 114.7 118 .

123 . 7 113. 8

4. 114 .9 118.0 123 . 7 113. 5

5 . 114 .6 118.0 123 . 7 113 . 7

RELATIVE INTENSITIES

VALID LO STD SAMPLE HI STD C

SET (x

1 ) (Y) (x

2

)

1 . 151 1 15 8 2 1 6f) D X1 O5 8O • n

2 . 151 . 3 158.6 160 .0 158 . 4

3. 151 . 3 158 . 5 160 .3 L58 . 3

4. 151 .

158.1 159 .3 158 . 5

5 . 151.4 158 .3 160 .0 158 . 0

93
DATA SHEET: STANDARD CURVE

PROTOCOL USED! MANUAL X SEM I -AUTOMATED

STANDARD

1

2

3

<+

5

> 6

CALCULATED ION

CONCENTRATION, MMOL/L

110.0

120.0

130.0

140.0

150 .0

160.0

RELATIVE

INTENSITY VALUES

113.6

CORRECTED RELATIVi

INTENSITY VALUES

122.4

131 . 7

141.6

151 .0

160 .0

DILUENT BLANK

LITHIUM BLANK
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3. Recipient's Accession No.

4. title and subtitle standard Reference Materials

A REFERENCE METHOD FOR THE DETERMINATION OF SODIUM IN SERUM

5. Publication Date August 1978

D. rcrfrirm in d Or cam 7afmn t r\A f

7. author(S) Ranee A, Velapoldi, Robert C. Paule, Robert Schaffer,

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16. ABSTRACT (A 200-word or less factual summary of most significant information. If document includes a significant

bibliography or literature survey, mention it here.)

Guided by a committee of experts in clinical chemistry, a reference method was established for the detPTmi nation of sprum c;rir] i 1 lm rm<;F>rl nn -Flamp> a-t-nm-i^ omiccinn

spectroscopy (FAES) . Its accuracy was evaluated by comparing the values obtained by

use of the method in twelve laboratories against the results obtained by a definitive

analytical method based on an ion-exchange sodium separation followed by gravimetry as Na2 S0i,. Seven serum pools with sodium concentrations in the range 113.2 to 158.6 mmol/L

were analyzed. Manual and semiautomated pipetting alternatives were tested using sample

sizes of 5.0 and 0.25 ml, respectively.

The laboratories used several different FAES instruments. The results showed that

the standard error for a single laboratory's performance of the procedure ranged from

0.46 to 0.86 mmol/L with a maximum bias of 1.0 mmol/L over the range of concentrations

studied. These values were within the accuracy and precision goals that had been set by

the committee. There were no significant differences in the results from the two

pipetting techniques. The calibration curve data showed excellent linearity over the

total concentration range, with 21 of 26 curves having standard deviations of fit of

0.5 mmol/L or less.

With appropriate experimental design, the reference method may be used to

establish the accuracy of field methods as well as to determine reference sodium values

for pooled sera.

17. KEY WORDS (six to twelve entries; alphabetical order; capitalize only the first letter of the first key word unless a proper name; separated by semicolons) Clinical analysis ; clinical chemistry; definitive method;

electrolytes; flame atomic emission spectroscopy; reference method; semiautomated

pipetting; serum sodium analysis.

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