Influence of Raised Plasma Osmolality on Clinical Outcome After Acute Stroke

Abstract

Background and Purpose-Abnormal physiological parameters after acute stroke may induce early neurological deterioration. Studies of the effect of dehydration on stroke outcome are limited. We examined the association of raised plasma osmolality on stroke outcome at 3 months and the change of plasma osmolality with hydration during the first week after stroke. Methods-Acute stroke patients had their plasma osmolality measured at admission and at days 1, 3, and 7. Maximum plasma osmolality and the area under curve (AUC) were also calculated during the first week. Patients were stratified according to how they were hydrated: orally, intravenously, or both. Outcome included survival at 3 months after stroke. Logistic regression was performed to examine the association between raised plasma osmolality (Ͼ296 mOsm/kg) and survival, adjusting for stroke severity. Linear regression was performed to examine the pattern of plasma osmolality across hydration groups. Results-One hundred sixty-seven patients were included. Mean admission (300 mOsm/kg, SD 11.4), maximum (308.1 mOsm/kg, SD 17.1), and AUC (298.3 mOsm/kg, SD 11.7) plasma osmolality were significantly higher in those who died compared with survivors (293.1 mOsm/kg [SD 8.2], 297.7 mOsm/kg [SD 8.7], and 291.7 mOsm/kg [SD 8.1], respectively; PϽ0.0001). Admission plasma osmolality Ͼ296 mOsm/kg was significantly associated with mortality (OR 2.4, 95% CI 1.0 to 5.9). In patients hydrated intravenously, there was no significant fall in plasma osmolality compared with patients hydrated orally (Pϭ0.68). Conclusions-Raised plasma osmolality on admission is associated with stroke mortality, after correcting for case mix.Correction of dehydration after stroke requires a more systematic approach. Trials are required to determine whether correcting dehydration after stroke improves outcome.

A Descriptive Study of the Fluid Intake, Hydration, and Health Status of Rehabilitation Inpatients without Dysphagia Following Stroke

“…Insufficient fluid intake may lead to dehydration, which in turn can have a significant negative impact on physical and cognitive function, overall recovery and quality of life [2]. Dehydration is particularly concerning for patients in the acute phase following stroke as it may affect the ischaemic penumbra, induce neurological deterioration, and influence the evolution of the stroke itself [3] and is associated with poorer outcomes at hospital discharge with regard to survival rate and dependency [4,5].…”

Dyselectrolytaemia in Acute Stroke Patients, an Observational Study

“…4 In our country, there are many studies on stroke, its associated conditions and their effect on stroke patient's outcome, but a few studies on electrolytes disturbance in stroke patients has been done in our country, even outside. 9 In this study, I attempted to find out the common electrolytes disturbances in acute stroke patients and its effect on the immediate outcome of the patients.…”

Guidelines for acute ischemic stroke treatment: part I

“…It is observed that specialized services for the treatment of stroke (stroke units) make use of a more aggressive intravenous hydration. Hypotonic fluids, however, can bring harm, as they elevate the risk of cerebral edema and intracranial hypertension, especially in extensive infarcts 65,66 . Hyperglycemia occurs in more than half of the patients in the acute phase of stroke, even the ones with no history of diabetes mellitus, and it is associated with increased morbidity and mortality, regardless of age, the mechanism of ischemic stroke or the extent of the ischemic injury.…”