Background:
Falls are the leading cause of accidental death in the elderly older than 65 years of age in the United States. Many factors lead to falls in the elderly, with a common etiology being medications Diuretics have shown a weak association with an increased risk of falls. The goal of this study was to determine if elderly patients admitted to the hospital with falls had a tendency to be hypovolemic. Blood urea nitrogen (BUN)/creatinine (Cr) ratio > 20 is often used as a marker of intravascular dehydration. It was hypothesized that diuretics may be contributing to elderly patients’ fall risk secondary to hypovolemia.
Methods:
A retrospective chart review was done at our tertiary‐care center. All patients were older than 65 years of age and were admitted from January 2007 to June 2007. The BUN/Cr ratios were compared in 2 groups of patients. The first group was elderly patients admitted to the trauma service with falls who were on diuretic(s). Group 2 was a comparison group of elderly patients admitted to the hospitalist service who were on diuretics but were admitted to the hospital for a reason other than a fall. Three groups of patients were examined based on stage of chronic kidney disease (CKD), stages 1 and 2, stage 3, and stage 4 and 5. Patients with end‐stage renal disease on hemodialysis were excluded from the study.
Results:
The results of the study demonstrated that patients with mild to moderate renal impairment with falls on diuretics generally had a higher overall BUN/Cr ratio than patients without falls on diuretics. In patients with stages 1 and 2 CKD, patients with falls on diuretics had a BUN/Cr ratio of 28.5 ± 1.2 (n = 78) versus 22.0 ± 0.9 (n = 71) in patients without falls on diuretics. In stage 3 CKD, the results were similar, with patients with falls on diuretics having a BUN/Cr ratio of 23.5 ± 1.1 (n = 46) versus 19.2 ± 1 (n = 59) in patients without falls on diuretics. In stages 4 and 5 CKD, the BUN/Cr ratio did not differ between the groups.
Conclusions:
Patients treated with diuretics admitted to the hospital with falls appear to more intravascularly depleted than patients on diuretics admitted to the hospital with diagnoses other than a fall. A significant state of intravascular volume depletion in patients on diuretics may be contributing to falls in the elderly. The results of our study suggest that patients with falls on diuretics had a higher BUN/Cr ratio than patients on diuretics without falls. It is speculated that the elevated BUN/Cr ratio reflects a hypovolemic state in the elderly that may be contributing to their falls. Elderly patients on diuretics should be monitored very closely for hypovolemia when treated with diuretics. It may be necessary to reduce diuretic medication doses or change medication if an elderly patients BUN/Cr ratio reaches a high level to reduce the risk of falls.
Disclosures:
M. Cratty ‐ none; G. Patel ‐ none