# Kim 2008 MELD-Na Kim 2008 MELD-Na Status: LIVE Price: $0.005 USDC `GET /api/calc/kim_meldna` HTML: https://magentlab.com/docs/kim-meldna Markdown: https://magentlab.com/docs/kim-meldna.md Not a medical device. Not a diagnosis, dose, or listing recommendation. ## What it computes Compute Kim 2008 NEJM MELD and MELD-Na from creatinine, bilirubin, INR, sodium, and dialysis using then-current UNOS lab bounds and sodium 125–140. ## When to use When an agent needs the Kim 2008 wait-list MELD-Na integer and must not substitute OPTN 2016 MELD-Na or Kim 2021 MELD 3.0, or invent a listing order. ## When not to use - Not a medical device. - Not a transplant listing or allocation order. - Kim 2008 NEJM MELD-Na only. This is not OPTN 2016 MELD-Na (sodium 125–137, applied only when MELD>11) and not Kim 2021 MELD 3.0. - Applies then-current UNOS creatinine 1.0–4.0 (dialysis sets 4.0) and bilirubin and INR floors of 1.0. - Bounds sodium at 125–140 mmol/L for the sodium term at every MELD. ## Formula ``` MELD = round(10 * (0.957*ln(Cr) + 0.378*ln(bili) + 1.120*ln(INR) + 0.643)); MELDNa = round(MELD - Na - 0.025*MELD*(140 - Na) + 140); dialysis sets Cr 4.0 else Cr clamp 1.0-4.0; bili and INR floor 1.0; Na bound 125-140. Kim 2008 NEJM, not OPTN 2016, not MELD 3.0 ``` ## Citation [Hyponatremia and mortality among patients on the liver-transplant waiting list](https://doi.org/10.1056/NEJMoa0801209) Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM N Engl J Med. 2008;359(10):1018-1026 DOI: [10.1056/NEJMoa0801209](https://doi.org/10.1056/NEJMoa0801209) ## Worked example ### Cr 1.2, bili 1.1, INR 1.1, Na 125 (paper: MELD 10 → MELDNa 21) Given: `bilirubin_mg_dl=1.1, creatinine_mg_dl=1.2, dialysis=false, inr=1.1, sodium_mmol_l=125` 1. Clamp labs per then-current UNOS (Na used = 125). 2. MELD = round(10 * (0.957*ln(Cr) + 0.378*ln(bili) + 1.120*ln(INR) + 0.643)) → 10 3. MELDNa = round(MELD - Na - 0.025*MELD*(140 - Na) + 140) → 21 (11 points added) ### Same labs, Na 140 (sodium term vanishes) Given: `bilirubin_mg_dl=1.1, creatinine_mg_dl=1.2, dialysis=false, inr=1.1, sodium_mmol_l=140` 1. Na used = 140, so 140 - Na = 0. 2. MELDNa = round(10 - 140 - 0 + 140) → 10 ## Also searched as - Kim 2008 MELD-Na - MELD sodium Kim NEJM - hyponatremia MELD waitlist - Kim MELDNa - not OPTN MELD-Na - wait-list MELD-Na 2008 ## Parameters - `creatinine_mg_dl` (number, optional): Serum creatinine in mg/dL (0.1-20). Provide this or creatinine_umol_l. Dialysis sets used creatinine to 4.0; otherwise clamp 1.0-4.0 (then-current UNOS, Kim 2008). - `creatinine_umol_l` (number, optional): Serum creatinine in µmol/L. Converted as mg/dL = µmol/L / 88.42. - `bilirubin_mg_dl` (number, optional): Total bilirubin in mg/dL (0.1-40). Provide this or bilirubin_umol_l. Floored at 1.0. - `bilirubin_umol_l` (number, optional): Total bilirubin in µmol/L. Converted as mg/dL = µmol/L / 17.1. - `inr` (number, required): INR (0.8-10). Floored at 1.0. - `sodium_mmol_l` (number, required): Serum sodium in mmol/L (110-160). Kim 2008 bounds the sodium term at 125-140. Applied at every MELD (not only MELD>11). - `dialysis` (boolean, required): Dialysis twice in the last week. true sets creatinine used to 4.0. ## Bulk (POST) POST the same path with a JSON items array. The first item is the GET unit; each additional item is $0.002. Invalid items return HTTP 400 before settlement. Method: `POST /api/calc/kim_meldna` Max items: 25 Price: unit_amount + extra_item_amount * (n - 1) (unit 5000 atomic, extra 2000 atomic) Status: PREVIEW - 1 to 25 items. Each item uses the same keys as the GET query parameters. - POST of 1 item costs the same as GET. Lists longer than 25: chunk into multiple POSTs. Extra items still execute; do not pad dummy rows. - The first invalid item fails the whole request (index in the 400 JSON). You are not charged. - HTTP 200 is {count, path, items}. Each items[i] is the GET 200 body for that row. - Catalog misses (empty matches, found=false) stay paid 200s inside that slot. - x402 resource URL is this path plus n and body_sha256. Browsers that prefer text/html get the same paywall as GET; Pay retries POST with the same items. Example request: ```json { "items": [ { "bilirubin_mg_dl": "1.1", "creatinine_mg_dl": "1.2", "dialysis": "false", "inr": "1.1", "sodium_mmol_l": "125" }, { "bilirubin_mg_dl": "1.1", "creatinine_mg_dl": "1.2", "dialysis": "false", "inr": "1.1", "sodium_mmol_l": "125" } ] } ``` Human paywall (two-item fixture): https://api.magentlab.com/paywall/bulk/kim-meldna Example 200: ```json { "count": 2, "path": "/api/calc/kim_meldna", "items": [ { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM", "doi": "10.1056/NEJMoa0801209", "id": "kim-2008-meldna", "pmid": "18768945", "source": "N Engl J Med. 2008;359(10):1018-1026", "title": "Hyponatremia and mortality among patients on the liver-transplant waiting list" }, "formula": "kim_meldna_2008", "formula_expression": "MELD = round(10 * (0.957*ln(Cr) + 0.378*ln(bili) + 1.120*ln(INR) + 0.643)); MELDNa = round(MELD - Na - 0.025*MELD*(140 - Na) + 140); dialysis sets Cr 4.0 else Cr clamp 1.0-4.0; bili and INR floor 1.0; Na bound 125-140. Kim 2008 NEJM, not OPTN 2016, not MELD 3.0", "bilirubin_mg_dl": 1.1, "creatinine_mg_dl": 1.2, "inr": 1.1, "sodium_mmol_l": 125.0, "meld": 10, "bilirubin_used_mg_dl": 1.1, "creatinine_used_mg_dl": 1.2, "dialysis": false, "inr_used": 1.1, "meld_na": 21, "sodium_used_mmol_l": 125.0 }, { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM", "doi": "10.1056/NEJMoa0801209", "id": "kim-2008-meldna", "pmid": "18768945", "source": "N Engl J Med. 2008;359(10):1018-1026", "title": "Hyponatremia and mortality among patients on the liver-transplant waiting list" }, "formula": "kim_meldna_2008", "formula_expression": "MELD = round(10 * (0.957*ln(Cr) + 0.378*ln(bili) + 1.120*ln(INR) + 0.643)); MELDNa = round(MELD - Na - 0.025*MELD*(140 - Na) + 140); dialysis sets Cr 4.0 else Cr clamp 1.0-4.0; bili and INR floor 1.0; Na bound 125-140. Kim 2008 NEJM, not OPTN 2016, not MELD 3.0", "bilirubin_mg_dl": 1.1, "creatinine_mg_dl": 1.2, "inr": 1.1, "sodium_mmol_l": 125.0, "meld": 10, "bilirubin_used_mg_dl": 1.1, "creatinine_used_mg_dl": 1.2, "dialysis": false, "inr_used": 1.1, "meld_na": 21, "sodium_used_mmol_l": 125.0 } ] } ``` ## Response fields - `formula` (string): kim_meldna_2008 - `formula_expression` (string): Exact expressions used - `creatinine_mg_dl` (number): Input creatinine in mg/dL - `bilirubin_mg_dl` (number): Input bilirubin in mg/dL - `inr` (number): Input INR - `sodium_mmol_l` (number): Input sodium - `dialysis` (boolean): Dialysis flag - `creatinine_used_mg_dl` (number): Creatinine after UNOS 1.0-4.0 bounds; dialysis forces 4.0 - `bilirubin_used_mg_dl` (number): Bilirubin after floor of 1.0 - `inr_used` (number): INR after floor of 1.0 - `sodium_used_mmol_l` (number): Sodium after Kim 2008 125-140 bound - `meld` (integer): Then-current UNOS MELD, nearest integer - `meld_na` (integer): Kim 2008 MELD-Na, nearest integer - `citation` (object): Kim 2008 NEJM citation - `disclaimer` (string): Not-a-device notice ## Example JSON Frozen fixture. Not a live lookup. ```json { "disclaimer": "Not a medical device. Deterministic published-formula or published-code output for autonomous agents. A licensed clinician remains responsible for patient care and billing submissions.", "citation": { "authors": "Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, Edwards E, Therneau TM", "doi": "10.1056/NEJMoa0801209", "id": "kim-2008-meldna", "pmid": "18768945", "source": "N Engl J Med. 2008;359(10):1018-1026", "title": "Hyponatremia and mortality among patients on the liver-transplant waiting list" }, "formula": "kim_meldna_2008", "formula_expression": "MELD = round(10 * (0.957*ln(Cr) + 0.378*ln(bili) + 1.120*ln(INR) + 0.643)); MELDNa = round(MELD - Na - 0.025*MELD*(140 - Na) + 140); dialysis sets Cr 4.0 else Cr clamp 1.0-4.0; bili and INR floor 1.0; Na bound 125-140. Kim 2008 NEJM, not OPTN 2016, not MELD 3.0", "bilirubin_mg_dl": 1.1, "creatinine_mg_dl": 1.2, "inr": 1.1, "sodium_mmol_l": 125.0, "meld": 10, "bilirubin_used_mg_dl": 1.1, "creatinine_used_mg_dl": 1.2, "dialysis": false, "inr_used": 1.1, "meld_na": 21, "sodium_used_mmol_l": 125.0 } ``` ## Errors - HTTP 400 `invalid_kim_meldna`: Kim 2008 MELD-Na needs bilirubin, INR, creatinine, sodium, and dialysis as in the NEJM formula. Returned before settlement; you are not charged. - HTTP 400 `invalid_creatinine`: creatinine_mg_dl (0.1-20) or creatinine_umol_l (9-1768) is required Returned before settlement; you are not charged. - HTTP 400 `invalid_bilirubin`: bilirubin_mg_dl (0.1-40) or bilirubin_umol_l (2-684) is required Returned before settlement; you are not charged. - HTTP 400 `invalid_inr`: inr must be a number from 0.8 to 10 Returned before settlement; you are not charged. - HTTP 400 `invalid_sodium`: sodium_mmol_l must be a number from 110 to 160 Returned before settlement; you are not charged. - HTTP 400 `invalid_flag`: boolean clinical flags must be true or false Returned before settlement; you are not charged. - HTTP 400 `invalid_items`: POST body must be a JSON object with only an items array Returned before settlement; you are not charged. - HTTP 400 `invalid_item_count`: items must be an array of 1 to 25 objects Returned before settlement; you are not charged. - HTTP 400 `invalid_item`: each items entry must be a JSON object Returned before settlement; you are not charged. Shared HTTP 402 and 503: https://magentlab.com/docs/payments ## Related tools - [MELD](https://magentlab.com/docs/meld) — Compute the Kamath 2001 model for end-stage liver disease (MELD) integer from creatinine, bilirubin, INR, and cholestatic or alcoholic etiology. - [MELD-Na](https://magentlab.com/docs/meld-na) — Compute OPTN/UNOS 2016 MELD and MELD-Na from creatinine, bilirubin, INR, sodium, and dialysis. - [MELD 3.0](https://magentlab.com/docs/meld-3) — Compute the Kim 2021 MELD 3.0 integer from sex, bilirubin, INR, creatinine, sodium, albumin, and dialysis. ## Payment Unpaid requests return HTTP 402 even if query parameters or POST items are missing or invalid, so CDP and agents can index the path. After a PAYMENT-SIGNATURE, invalid params return HTTP 400 JSON before settlement. magent does not charge. Fix the params, then request a new 402 quote for that complete URL. Catalog misses (empty matches, found=false) are valid paid 200s. - GET the tool with Accept: application/json (do not send Accept: text/html unless you want the human paywall). - HTTP 402 means you have not paid. Decode the base64 PAYMENT-REQUIRED header. HTTP 503 is not a new quote. - Sign accepts[0] (exact, EIP-3009) with validBefore = now + maxTimeoutSeconds (600 seconds), or accepts[1] (batch-settlement deposit/voucher) on product GET. Ping and POST {items} stay exact. Magent retries transient facilitator 429/5xx before answering. - Retry the same URL with PAYMENT-SIGNATURE (base64 JSON of accepted and payload). Magent attaches canonical extensions.bazaar on CDP verify/settle; echoing 402 bazaar is optional. - Success is HTTP 200 JSON plus PAYMENT-RESPONSE. exact settles before the tool. batch-settlement verifies (and deposit-settles) before the tool and commits the charge after HTTP 2xx. HTTP 503: retry the same PAYMENT-SIGNATURE. Mint a new exact nonce only after a new HTTP 402. - offered `exact` on eip155:8453: Fixed-price USDC on Base. The buyer authorizes the advertised amount (EIP-3009). magent settles before the tool runs (paymentFlow upfront). extra.assetTransferMethod=eip3009 extra.paymentFlow=upfront. - offered `batch-settlement` on eip155:8453: Payment-channel vouchers claimed later in batches. Exact stays accepts[0]. Same-path POST {items} is still exact. extra.assetTransferMethod=eip3009 extra.paymentFlow=authorization. - not offered `upto`: Not offered. Usage-based: buyer authorizes a ceiling, seller settles the actual amount after work. Reserved for a future metered tool. Not for current calculators or code search. Same-path POST {items} is still scheme exact: one EIP-3009 authorization for GET unit plus $0.002 per extra item. That is not x402 batch-settlement (payment channels / vouchers). Shared HTTP 402 and 503 table: https://magentlab.com/docs/payments Stdio MCP (one process per host): https://magentlab.com/docs/mcp ## Guarantees - HTTP 402 is unpaid, including a missing query. After PAYMENT-SIGNATURE, invalid parameters return HTTP 400 before settlement. You are not charged. HTTP 402 never includes the tool JSON. - exact: settlement finishes before the tool (paymentFlow upfront). batch-settlement: verify/deposit before the tool; chargedCumulativeAmount commits after HTTP 2xx. Uncertain or failed settlement fails closed (HTTP 503). Retry the same PAYMENT-SIGNATURE. - HTTP 402 is unpaid only. Do not sign a second authorization because of a 503. - Execution is timeout-bounded and concurrency-capped. - Calculator inputs are stored encrypted for allowlisted operators (Magent Console). They are not in public logs, SSH lookups, catalog, or rollups. Request logs store path without query.