the deepest known fish in the world, the hadal snailfish (Notoliparis kermadecensis) having a recorded muscle osmolality of 991 ± 22 mOsmol/kg, almost four times the osmolality of mammals and three times that of shallow water fish species (typically 350 mOsmol/kg). Clinical relevance As cell membranes in general are freely permeable to water, the osmolality of the extracellular fluid (ECF) is approximately equal to that of the intracellular fluid (ICF). Therefore, plasma osmolality is a guide to intracellular osmolality. This is important, as it shows that changes in ECF osmolality have a great effect on ICF osmolality — changes that can cause problems with normal cell functioning and volume. If the ECF were to become too hypotonic, water would readily fill surrounding cells, increasing their volume and potentially lysing them (cytolysis). Many poisons, medications and diseases affect the balance between the ICF and ECF, affecting individual cells and homeostasis as a whole. Osmolality of blood increases with dehydration and decreases with overhydration. In normal people, increased osmolality in the blood will stimulate secretion of antidiuretic hormone (ADH). This will result in increased water reabsorption, more concentrated urine, and less concentrated blood plasma. A low serum osmolality will suppress the release of ADH, resulting in decreased water reabsorption and more concentrated plasma. Syndrome of inappropriate ADH secretion occurs when excessive release of antidiuretic hormone results in inappropriately elevated urine osmolality (>100 mOsmol/L) relative to the blood plasma, leading to hyponatraemia. This ADH secretion may occur in excessive amounts from the posterior pituitary gland, or from ectopic sources such as small-cell carcinoma of the lung. Elevation may be associated with stroke mortality. Calculated osmolarity (CO) In medical lab reports, this quantity often appears as "Osmo, Calc" or "Osmo (Calc)." According to the international SI unit use the following equation : Calculated osmolarity = 2 Na + Glucose + Urea (all in mmol/L) As Na+ is the major extracellular cation, the sum of osmolarity of all other anions can be assumed to be equal to natremia, hence [Na+]x2 ≈ [Na+] + [anions] To calculate plasma osmolality use the following equation (typical in the US): = 2[] + [Glucose]/18 + [ BUN ]/2.8 where [Glucose] and [BUN] are measured in mg/dL. If the patient has ingested ethanol, the ethanol level should be included in the calculated osmolarity: = 2[] + [Glucose]/18 + [ BUN ]/2.8 + [Ethanol]/3.7 Based on the molecular weight of ethanol