Volaemic assessment of the elderly hyponatraemic patient: reliability of clinical assessment and validation of bioelectrical impedance analysis

G E Hoyle, M Chua, R L Soiza

Research output: Contribution to journalArticle

19 Citations (Scopus)

Abstract

BACKGROUND: Hyponatraemia is the commonest electrolyte disturbance of hospital inpatients. Assessment of volaemic status is an important part of diagnosis and management.

AIM: To determine reliability of clinical assessment of volaemic state by assessing inter-observer variability of clinical measures of volaemic state. To assess validity of bioelectrical impedance analysis as a tool to measure total body water in elderly hyponatraemic patients.

DESIGN: Observational study conducted in a Department of Medicine for the Elderly.

METHODS: Hospital inpatients >65 years old (n=22) with serum sodium concentration <130 mmol/l were included. Two assessors determined volaemic state on two occasions 72 h apart. Level of agreement between observers was determined on each occasion. Total body water estimation was undertaken with bioelectrical impedance analysis and measurement of dilution of deuterium oxide. Correlation between these two measures was then analysed.

RESULTS: Cohen's κ for agreement between two observers for overall assessment of volaemic state was 0.59 (P<0.01). Values for agreement between individual clinical markers of volaemic state ranged between 0.16 and 0.45. Pearson correlation coefficient (r) for correlation between estimation of total body water undertaken by bioelectrical impedance analysis and by measurement of dilution of deuterium oxide was 0.69 (P<0.001).

CONCLUSION: There was moderate inter-observer agreement of overall clinical volaemic assessment of elderly hyponatraemic patients. Total body water estimation by bioelectrical impedance analysis correlates well with estimation by measurement of dilution of deuterium oxide, providing a potentially useful tool to improve the management of the elderly hyponatraemic patient.

Original languageEnglish
Pages (from-to)35-39
Number of pages5
JournalQJM
Volume104
Issue number1
Early online date7 Sep 2010
DOIs
Publication statusPublished - Jan 2011

Fingerprint

Body Water
Deuterium Oxide
Electric Impedance
Inpatients
Observer Variation
Hyponatremia
Electrolytes
Observational Studies
Biomarkers
Sodium
Medicine
Serum

Keywords

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Body Composition
  • Body Water
  • Electric Impedance
  • Female
  • Humans
  • Hyponatremia
  • Male
  • Reproducibility of Results
  • Sodium
  • Water-Electrolyte Balance
  • Journal Article
  • Research Support, Non-U.S. Gov't

Cite this

Volaemic assessment of the elderly hyponatraemic patient : reliability of clinical assessment and validation of bioelectrical impedance analysis. / Hoyle, G E; Chua, M; Soiza, R L.

In: QJM, Vol. 104, No. 1, 01.2011, p. 35-39.

Research output: Contribution to journalArticle

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N2 - BACKGROUND: Hyponatraemia is the commonest electrolyte disturbance of hospital inpatients. Assessment of volaemic status is an important part of diagnosis and management.AIM: To determine reliability of clinical assessment of volaemic state by assessing inter-observer variability of clinical measures of volaemic state. To assess validity of bioelectrical impedance analysis as a tool to measure total body water in elderly hyponatraemic patients.DESIGN: Observational study conducted in a Department of Medicine for the Elderly.METHODS: Hospital inpatients >65 years old (n=22) with serum sodium concentration <130 mmol/l were included. Two assessors determined volaemic state on two occasions 72 h apart. Level of agreement between observers was determined on each occasion. Total body water estimation was undertaken with bioelectrical impedance analysis and measurement of dilution of deuterium oxide. Correlation between these two measures was then analysed.RESULTS: Cohen's κ for agreement between two observers for overall assessment of volaemic state was 0.59 (P<0.01). Values for agreement between individual clinical markers of volaemic state ranged between 0.16 and 0.45. Pearson correlation coefficient (r) for correlation between estimation of total body water undertaken by bioelectrical impedance analysis and by measurement of dilution of deuterium oxide was 0.69 (P<0.001).CONCLUSION: There was moderate inter-observer agreement of overall clinical volaemic assessment of elderly hyponatraemic patients. Total body water estimation by bioelectrical impedance analysis correlates well with estimation by measurement of dilution of deuterium oxide, providing a potentially useful tool to improve the management of the elderly hyponatraemic patient.

AB - BACKGROUND: Hyponatraemia is the commonest electrolyte disturbance of hospital inpatients. Assessment of volaemic status is an important part of diagnosis and management.AIM: To determine reliability of clinical assessment of volaemic state by assessing inter-observer variability of clinical measures of volaemic state. To assess validity of bioelectrical impedance analysis as a tool to measure total body water in elderly hyponatraemic patients.DESIGN: Observational study conducted in a Department of Medicine for the Elderly.METHODS: Hospital inpatients >65 years old (n=22) with serum sodium concentration <130 mmol/l were included. Two assessors determined volaemic state on two occasions 72 h apart. Level of agreement between observers was determined on each occasion. Total body water estimation was undertaken with bioelectrical impedance analysis and measurement of dilution of deuterium oxide. Correlation between these two measures was then analysed.RESULTS: Cohen's κ for agreement between two observers for overall assessment of volaemic state was 0.59 (P<0.01). Values for agreement between individual clinical markers of volaemic state ranged between 0.16 and 0.45. Pearson correlation coefficient (r) for correlation between estimation of total body water undertaken by bioelectrical impedance analysis and by measurement of dilution of deuterium oxide was 0.69 (P<0.001).CONCLUSION: There was moderate inter-observer agreement of overall clinical volaemic assessment of elderly hyponatraemic patients. Total body water estimation by bioelectrical impedance analysis correlates well with estimation by measurement of dilution of deuterium oxide, providing a potentially useful tool to improve the management of the elderly hyponatraemic patient.

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KW - Electric Impedance

KW - Female

KW - Humans

KW - Hyponatremia

KW - Male

KW - Reproducibility of Results

KW - Sodium

KW - Water-Electrolyte Balance

KW - Journal Article

KW - Research Support, Non-U.S. Gov't

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JO - QJM

JF - QJM

SN - 1460-2725

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