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Body composition, energy expenditure and physical activity

Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0.9%

European Journal of Clinical Nutrition volume 74, pages 1638–1645 (2020)Cite this article

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Abstract

Background

Fluid balance management in hospitalized patients is hampered by the limited sensitivity of currently available tools. The aim of this study was to assess the sensitivity of total body electrical resistance (TBER) measurements for the detection of extracellular volume (ECV) expansion.

Methods

TBER and plasma resistivity (ρplasma) were measured during a 4-h infusion of NaCl 0.9% at a rate of 500 mL/h in 23 patients undergoing a diagnostic saline infusion test for primary hyperaldosteronism. Extracellular fluid gain (EFG) was defined as infusion volume minus urinary volume.

Results

Infusion of 2.0 L NaCl 0.9% was associated with a mean diuresis of 1.1 ± 0.5 L, an EFG of 0.9 ± 0.5 L, a decrease in ρplasma of 1.1 ± 0.7 Ω·cm or 1.7 ± 1.0% (P < 0.001), and a decline in TBER of 23.2 ± 10.9 Ω or 4.6 ± 2.2% (P < 0.001). At group level, infusion of 80 mL saline was sufficient to induce a statistically significant decline in mean TBER. At personal level, the decline in TBER was significant on 76% of occasions after an EFG of 0.5–0.75 L, and on all occasions after an EFG of 1.0 L or greater.

Conclusion

Raw TBER data are very informative for the detection of ECV expansion induced by the infusion of NaCl 0.9%, with a sensitivity at a personal level that is relevant for clinical practice.

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Fig. 1: Individual changes in ρplasma after infusion of 2 L NaCl 0.9%.
Fig. 2: TBER changes in response to infusion of NaCl 0.9% at a rate of 500 mL/h.
Fig. 3: TBER responses to changes in fluid balance.
Fig. 4: Sensitivity of TBER to volume loading in individual subjects.

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Acknowledgements

The authors wish to thank Kurt Quarz and Damir Djulbic for their help with plasma resistivity measurements at the Rijnstate Hospital laboratory.

Funding

This study was financed by the Radboud-Rijnstate PhD funding.

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Authors and Affiliations

  1. Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands

    J. M. Schotman, L. J. M. Reichert & H. de Boer

  2. Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands

    M. M. G. J. van Borren

  3. Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands

    J. F. M. Wetzels & H. J. Kloke

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  1. J. M. Schotman
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Contributions

JS, MB, and HB designed the study; JS conducted research; JS, MB, and HB, analyzed data; JS, MB, and HB wrote the paper; JW, HK, and LR reviewed the article critically and contributed important intellectual content; HB had primary responsibility for final content. All authors read and approved the final paper.

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Correspondence to J. M. Schotman.

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Schotman, J.M., van Borren, M.M.G.J., Wetzels, J.F.M. et al. Sensitivity of total body electrical resistance measurements in detecting extracellular volume expansion induced by infusion of NaCl 0.9%. Eur J Clin Nutr 74, 1638–1645 (2020). https://doi.org/10.1038/s41430-020-0655-y

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