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Osmolality is a measure of the concentration of solute in various fluids such as blood, urine, serum, etc...
Osmolality is required for the following diagnostic reasons: 
Screening for toxin ingestion
Alcohols (Methanol, Isopropanol)
Glycols (Ethylene, Propylene)
Monitoring the concentration of osmotically active agents

Assessment of Hyponatremia
Ruling out pseudo-hyponatremia
Presence of additional osmotic agents (Glycine, Glucose)
Assessment of increased urinary excretion
Primary Polydipsia (low serum and low urine osmolality)
Diabetes insipidus (high serum and low urine osmolality)
Diabetes mellitus (high serum and high urine osmolality)
Assessment of decreased urinary excretion
Dehydration (high urine osmolality, negative free water clearance)
Acute tubular injury (free water clearance)
Evaluation of renal acidification defects
Urine osmolal gap  = excretion of NH4
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