{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T14:21:54Z","timestamp":1793283714994,"version":"4.5.0"},"reference-count":47,"publisher":"BMJ","issue":"8","funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2017,6,21]]},"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We aimed to determine if abnormal laboratory values which may indicate volume depletion are associated with increased odds of experiencing a hospital-acquired fall.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Matched case\u2013control study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Four hospitals located in the Southeast USA.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Data from 699 adult fallers and 1189 matched controls (non-fallers) were collected via chart review from 2005 to 2010. Controls were matched to cases by nursing unit, time of fall and length of stay.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>The primary exposures included serum sodium, blood urea nitrogen (BUN), creatinine, BUN\/creatinine ratio and haematocrit. Conditional logistic regression with m:n matching was used to determine adjusted and unadjusted ORs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Serum sodium levels were strongly associated with falls. In models controlling for demographic and other fall risk factors, patients with serum sodium levels of 125 mEq\/L or less were associated with increased odds of experiencing a fall as compared with those with serum sodium levels of greater than 134 mEq\/L (adjusted OR (aOR)=5.08, 95% CI 1.43 to 18.08). Conversely, elevated BUN, creatinine and elevated BUN\/creatinine ratios were not associated with increased odds of experiencing a fall (aOR=0.64, 95% CI 0.49 to 0.84; aOR=0.70, 95% CI 0.54 to 0.92 and aOR=0.77, 95% CI 0.58 to 1.04, respectively.)<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Laboratory indices that may indicate volume depletion appear to be unrelated to falls. However, hyponatraemia does appear to be a risk factor for falls, and those with serum sodium levels below 126 mEq\/L are at especially high risk. It may be that other deficits associated with hyponatraemia, like altered mental status, are associated with risk of experiencing a hospital-acquired fall. These results indicate that abnormal laboratory values, like low sodium, can be useful for identifying hospitalised patients at risk of falling. Therefore, further investigation into abnormal laboratory values as predictors of hospital-acquired falls is warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-017045","type":"journal-article","created":{"date-parts":[[2017,8,8]],"date-time":"2017-08-08T20:10:14Z","timestamp":1502223014000},"page":"e017045","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":24,"title":["Associations between hyponatraemia, volume depletion and the risk of falls in US hospitalised patients: a case\u2013control study"],"prefix":"10.1136","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9002-7706","authenticated-orcid":false,"given":"Elizabeth A","family":"Fehlberg","sequence":"first","affiliation":[{"name":"Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA"},{"name":"Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA"},{"name":"Division of Research on Healthcare Value, Equity, and the Lifespan, RTI International, Research Triangle Park, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J","family":"Lucero","sequence":"additional","affiliation":[{"name":"Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA"},{"name":"Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA"},{"name":"Center for Innovation on Disability and Rehabilitation Research (CINDRR), Malcom Randall VAMC, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael T","family":"Weaver","sequence":"additional","affiliation":[{"name":"Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna M","family":"McDaniel","sequence":"additional","affiliation":[{"name":"Departments of Biobehavioral Nursing and Family, Community, and Health System Science, University of Florida College of Nursing, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A Michelle","family":"Chandler","sequence":"additional","affiliation":[{"name":"Methodist Healthcare University Hospital, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Phyllis A","family":"Richey","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lorraine C","family":"Mion","sequence":"additional","affiliation":[{"name":"Center of Excellence in Critical and Complex Care, The Ohio State University College of Nursing, Columbus, Ohio, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ronald I","family":"Shorr","sequence":"additional","affiliation":[{"name":"Clinical and Translational Science Institute, University of Florida, Gainesville, Florida, USA"},{"name":"Geriatric Research Education and Clinical Centers (GRECC), Malcom Randall VAMC, Gainesville, Florida, USA"},{"name":"Department of Epidemiology, University of Florida, Gainesville, Florida, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2017,8,7]]},"reference":[{"key":"2025120600263334000_7.8.e017045.1","unstructured":"Centers for Disease Control and Prevention. Falls among older adults: an overview. https:\/\/www.cdc.gov\/HomeandRecreationalSafety\/Falls\/adultfalls.html. (accessed Jun 2015)."},{"key":"2025120600263334000_7.8.e017045.2","unstructured":"Ganz DA , Huang C , Saliba D , et al . Agency for Healthcare Research and Quality. Preventing falls in hospitals: a toolkit for improving quality of care. 2013. https:\/\/www.ahrq.gov\/sites\/default\/files\/publications\/files\/fallpxtoolkit.pdf. (accessed Jun 2015)."},{"key":"2025120600263334000_7.8.e017045.3","doi-asserted-by":"publisher","DOI":"10.1097\/pts.0b013e318030c2ff"},{"key":"2025120600263334000_7.8.e017045.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0897-1897(95)80592-3"},{"key":"2025120600263334000_7.8.e017045.5","doi-asserted-by":"publisher","DOI":"10.1053\/apnr.2003.016009"},{"key":"2025120600263334000_7.8.e017045.6","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.40171.x"},{"key":"2025120600263334000_7.8.e017045.7","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1097\/00001786-200504000-00007","article-title":"Predicting in-hospital falls: development of the Scott and White Falls Risk Screener","volume":"20","author":"Yauk","year":"2005","journal-title":"J Nurs Care Qual"},{"key":"2025120600263334000_7.8.e017045.8","doi-asserted-by":"publisher","DOI":"10.1093\/geront\/27.4.516"},{"key":"2025120600263334000_7.8.e017045.9","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3928\/0098-9134-19981201-05","article-title":"A case control study of falls in the hospital setting","volume":"24","author":"Ash","year":"1998","journal-title":"J Gerontol Nurs"},{"key":"2025120600263334000_7.8.e017045.10","first-page":"81","article-title":"Prevention of falls in older patients","volume":"72","author":"Rao","year":"2005","journal-title":"Am Fam Physician"},{"key":"2025120600263334000_7.8.e017045.11","doi-asserted-by":"publisher","DOI":"10.1017\/S0714980800008576"},{"key":"2025120600263334000_7.8.e017045.12","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.315.7115.1049"},{"key":"2025120600263334000_7.8.e017045.13","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1186\/1472-6963-13-122","article-title":"Instruments for assessing the risk of falls in acute hospitalized patients: a systematic review and meta-analysis","volume":"13","author":"Aranda-Gallardo","year":"2013","journal-title":"BMC Health Serv Res"},{"key":"2025120600263334000_7.8.e017045.14","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2007.11.006"},{"key":"2025120600263334000_7.8.e017045.15","doi-asserted-by":"publisher","DOI":"10.1111\/j.1471-6712.1992.tb00133.x"},{"key":"2025120600263334000_7.8.e017045.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jamda.2005.10.010"},{"key":"2025120600263334000_7.8.e017045.17","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-172X.2005.00519.x"},{"key":"2025120600263334000_7.8.e017045.18","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjsurg.2009.12.013"},{"key":"2025120600263334000_7.8.e017045.19","doi-asserted-by":"publisher","DOI":"10.1188\/12.ONF.E407-E415"},{"key":"2025120600263334000_7.8.e017045.20","doi-asserted-by":"publisher","DOI":"10.1097\/01376517-199006000-00003"},{"key":"2025120600263334000_7.8.e017045.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.archger.2006.01.004"},{"key":"2025120600263334000_7.8.e017045.22","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/54.1.M38"},{"key":"2025120600263334000_7.8.e017045.23","doi-asserted-by":"publisher","DOI":"10.2146\/ajhp050116"},{"key":"2025120600263334000_7.8.e017045.24","doi-asserted-by":"publisher","DOI":"10.1097\/JCP.0b013e318218f446"},{"key":"2025120600263334000_7.8.e017045.25","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1038\/ejcn.2014.195","article-title":"Hyponatremia and hypokalemia as risk factors for falls","volume":"69","author":"Tachi","year":"2015","journal-title":"Eur J Clin Nutr"},{"key":"2025120600263334000_7.8.e017045.26","doi-asserted-by":"publisher","DOI":"10.1067\/mgn.2002.126967"},{"key":"2025120600263334000_7.8.e017045.27","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afl084"},{"key":"2025120600263334000_7.8.e017045.28","first-page":"91","article-title":"Fall prevention in the elderly","volume":"10","author":"Ungar","year":"2013","journal-title":"Clin Cases Miner Bone Metab"},{"key":"2025120600263334000_7.8.e017045.29","doi-asserted-by":"publisher","DOI":"10.1016\/j.cger.2015.04.007"},{"key":"2025120600263334000_7.8.e017045.30","doi-asserted-by":"publisher","DOI":"10.1016\/0736-4679(92)90331-M"},{"key":"2025120600263334000_7.8.e017045.31","doi-asserted-by":"publisher","DOI":"10.1001\/jama.281.11.1022"},{"key":"2025120600263334000_7.8.e017045.32","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1016\/j.annemergmed.2004.09.021","article-title":"Clinical assessment of hypovolemia","volume":"45","author":"Sinert","year":"2005","journal-title":"Ann Emerg Med"},{"key":"2025120600263334000_7.8.e017045.33","first-page":"1800","article-title":"Identification of the hydration state in emergency patients: correlation between caval index and BUN\/creatinine ratio","volume":"17","author":"Riccardi","year":"2013","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"2025120600263334000_7.8.e017045.34","doi-asserted-by":"publisher","DOI":"10.1159\/000233057"},{"key":"2025120600263334000_7.8.e017045.35","doi-asserted-by":"crossref","first-page":"S67","DOI":"10.1016\/S1525-8610(04)70099-7","article-title":"Dehydration despite drinking: beyond the BUN\/creatinine ratio","volume":"5","author":"Robinson","year":"2004","journal-title":"J Am Med Dir Assoc"},{"key":"2025120600263334000_7.8.e017045.36","unstructured":"Van Leeuwen AM , Bladh ML . Davis's comprehensive handbook of laboratory & diagnostic tests with nursing implications. 6th ed. Philadelphia, PA: F.A. DavisCo, 2015."},{"key":"2025120600263334000_7.8.e017045.37","doi-asserted-by":"crossref","unstructured":"Simon EE . Hyponatremia evaluation and treatment. New York, NY: \u00a0Springer, 2013.","DOI":"10.1007\/978-1-4614-6645-1"},{"key":"2025120600263334000_7.8.e017045.38","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2011.05672.x"},{"key":"2025120600263334000_7.8.e017045.39","unstructured":"SAS Institute Inc. SAS\/STAT 9.2 user's guide conditional logisitc regression for matched pairs data. 2nd ed. Cary,\u00a0NC: SAS Institute Inc, 2009."},{"key":"2025120600263334000_7.8.e017045.40","unstructured":"Allison PD . Logistic regression using SAS: theory and application. 2nd ed. Cary, NC: SAS Institute Inc, 2012. https:\/\/support.sas.com\/documentation\/cdl\/en\/statug\/63033\/HTML\/default\/viewer.htm#statug_logistic_sect062.htm. (accessed Aug 2016)."},{"key":"2025120600263334000_7.8.e017045.41","doi-asserted-by":"crossref","first-page":"119","DOI":"10.1016\/j.injury.2014.06.013","article-title":"Hyponatremia as a fall predictor in a geriatric trauma population","volume":"46","author":"Rittenhouse","year":"2015","journal-title":"Injury"},{"key":"2025120600263334000_7.8.e017045.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2005.09.026"},{"key":"2025120600263334000_7.8.e017045.43","doi-asserted-by":"publisher","DOI":"10.1111\/imj.12535"},{"key":"2025120600263334000_7.8.e017045.44","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.12468"},{"key":"2025120600263334000_7.8.e017045.45","doi-asserted-by":"publisher","DOI":"10.1002\/nur.20399"},{"key":"2025120600263334000_7.8.e017045.46","doi-asserted-by":"publisher","DOI":"10.1097\/HMR.0000000000000013"},{"key":"2025120600263334000_7.8.e017045.47","doi-asserted-by":"publisher","DOI":"10.1111\/jgs.13387"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-017045","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,6]],"date-time":"2025-12-06T08:26:38Z","timestamp":1765009598000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-017045"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2017,8]]},"references-count":47,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2017,8,7]]},"published-print":{"date-parts":[[2017,8]]}},"alternative-id":["10.1136\/bmjopen-2017-017045"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-017045","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,8]]}}}