title: Volaemic assessment of the elderly hyponatraemic patient: reliability of clinical assessment and validation of bioelectrical impedance analysis.
abstract: BACKGROUND
  Hyponatraemia is the commonest electrolyte disturbance of hospital inpatients. Assessment of volaemic status is an important part of diagnosis and management.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Medicine for the Elderly, Woodend Hospital, Eday Road, Aberdeen AB15 6XS, Scotland, UK. graeme.hoyle@nhs.net
authors.forename: G E
authors.initials: GE
authors.lastname: Hoyle
authors.forename: M
authors.initials: M
authors.lastname: Chua
authors.forename: R L
authors.initials: RL
authors.lastname: Soiza
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001823:Body Composition; D001834:Body Water / Q000378:metabolism*; D017097:Electric Impedance; D005260:Female; D006801:Humans; D007010:Hyponatremia / Q000503:physiopathology*; D008297:Male; D015203:Reproducibility of Results; D012964:Sodium / Q000502:physiology*; D014882:Water-Electrolyte Balance / Q000502:physiology*
chemical_list: D012964:Sodium