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Bioelectrical Impedance Analysis Is Not Sufficient for Determining Water Deficit in Hypernatremic Patients

Se-Hee Yoon, Seul-gi Kim, In-Beom Jeong, Won-Min Hwang, Sung-Ro Yun

Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, South Korea

Med Sci Monit 2019; 25:8438-8446

DOI: 10.12659/MSM.918095

Available online:

Published: 2019-11-09


BACKGROUND: Hypernatremia is associated with poor outcomes in critically ill patients, and an accurate assessment of water volume is important to determine appropriate fluid hydration. Bioelectrical impedance analysis (BIA) is a new, noninvasive, and relatively easy method for measuring hydration status. This study aimed to investigate whether bioelectrical impedance measurements of body water could reduce the frequency of blood sampling for fluid replacement in patients with hypernatremia.
MATERIAL AND METHODS: Fifty-one hospitalized patients were studied with hypernatremia, defined as a serum sodium ≥150 mmol/L determined by laboratory testing. Laboratory and BIA measurements were compared, and water deficiency was calculated with a conventional formula (sodium-corrected Watson formula) and measured by BIA.
RESULTS: The value of the absolute fluid overload (AFO) equivalent to the overhydration (OH) value, determined using BIA, did not accurately represent water deficit in patients with hypernatremia (r=0.137, P=0.347). Although the total body water (TBW) measured by BIA showed a significant correlation with that determined by the conventional formula (r=0.861, P<0.001), there was a proportional bias (r=0.617, P<0.001). The intracellular water (ICW) measured by BIA underestimated the TBW level calculated by the conventional formula by about 14.06±4.0 L in the Bland-Altman analysis.
CONCLUSIONS: It is not currently possible to replace blood testing with BIA for assessing volume status in hypernatremic patients. However, ICW value measured by BIA might represent plasma sodium level more accurately than extracellular water (ECW) or TBW value in patients with hypernatremia.

Keywords: Body Fluids, Dehydration, Electric Impedance, Hypernatremia



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