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Bioelectrical impedance analysis is more accurate than clinical examination in determining the volaemic status of elderly patients with fragility fracture and hyponatraemia

  • Published:
The journal of nutrition, health & aging

Abstract

Objectives

Management of hyponatraemia depends crucially on accurate determination of volaemic (hydration) status but this is notoriously challenging to measure in older people. Bioelectrical impedance analysis (BIA) provides a validated means of determining total body water (TBW), but its clinical utility in determining volaemic status in hyponatraemia has never been tested. This study assessed the utility of BIA in the clinical management of hyponatraemia in elderly patients with fragility fractures (EPFF), a group at high risk of hyponatraemia.

Design

Prospective observational study of consenting patients ≥65 years with fragility fractures (N=127).

Setting

University teaching hospital in Scotland.

Participants

Patients ≥65 years with fragility fractures with capacity to consent to participation.

Measurements

BIA and standard clinical examination procedures (jugular venous distension, skin turgor, mouth and axillary moistness, peripheral oedema, capillary refill time, overall impression) were performed daily throughout each participant’s hospital stay. Volaemic status of hyponatraemia was determined by an expert panel using clinical data (history, examination, nursing observations and laboratory tests) blinded to TBW readings. Cohen’s kappa was calculated to assess the level of agreement between the expert panel and both BIA and standard clinical examination measures in determining the volaemic state of hyponatraemia.

Results

26/33 (79%) cases of hyponatraemia had sufficient clinical information to allow determination of volaemic status by BIA. There was moderate level of agreement between BIA and the expert panel, kappa 0.52 (p<.001). All kappa values for standard clinical assessments of volaemic status neared zero, indicating nil to slight agreement.

Conclusion

BIA outperformed all aspects of the standard clinical examination in determining the volaemic status of hyponatraemic EPFF, suggesting it may be useful in clinical practice.

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Authors and Affiliations

  1. Department of Medicine for the Elderly, NHS Grampian, Aberdeen, UK

    K. Cumming, G. E. Hoyle & Roy L. Soiza

  2. University of Aberdeen Medical School, Aberdeen, UK

    K. Cumming, J. D. Hutchison & Roy L. Soiza

Authors
  1. K. Cumming
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  2. G. E. Hoyle
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  3. J. D. Hutchison
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  4. Roy L. Soiza
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Correspondence to Roy L. Soiza.

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Cumming, K., Hoyle, G.E., Hutchison, J.D. et al. Bioelectrical impedance analysis is more accurate than clinical examination in determining the volaemic status of elderly patients with fragility fracture and hyponatraemia. J Nutr Health Aging 18, 744–750 (2014). https://doi.org/10.1007/s12603-014-0539-8

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  • DOI: https://doi.org/10.1007/s12603-014-0539-8

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