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Inorganic apparent strong ion difference (SIDai) improves chloride-associated acidosis recognition in dysnatremic patients. We investigated whether the difference between sodium and chloride (Na⁺-Cl⁻) or the ratio between chloride and sodium (Cl⁻/Na⁺) could be used as SIDai surrogates in mixed and dysnatremic patients.

Two arterial blood samples were collected from 128 patients. Physicochemical analytical approach was used. Correlation, agreement, accuracy, sensitivity, and specificity were measured to examine whether Na⁺-Cl⁻ and Cl⁻/Na⁺ could be used instead of SIDai in the diagnosis of acidosis.

Na⁺-Cl⁻ and Cl⁻/Na⁺ were well correlated with SIDai (R = 0.987, P < 0.001 and R = 0.959, P < 0.001, respectively). Bias between Na⁺-Cl⁻ and SIDai was high (6.384 with a limit of agreement of 4.463-8.305 mEq/L). Accuracy values for the identification of …