Magazine article Clinical Psychiatry News

Dehydration May Worsen Clinical Status in Stroke

Magazine article Clinical Psychiatry News

Dehydration May Worsen Clinical Status in Stroke

Article excerpt

AT THE INTERNATIONAL STROKE CONFERENCE

NASHVILLE, TENN. -- Patients who were clinically dehydrated when they presented with ischemic stroke were four times more likely to worsen over the next few days than were adequately hydrated patients in a single-center, retrospective study.

Hydration status didn't appear to affect stroke infarct volume or severity, Dr. Mona Bahouth reported in a press briefing at the International Stroke Conference. Nevertheless, 42% of those considered dehydrated had no improvement or worsened during their stay, compared with 17% of the well-hydrated patients, said Dr. Bahouth, a neurology fellow at Johns Hopkins University, Baltimore.

It's unclear how many stroke patients receive hydration therapy upon admission, she said. It's also unclear how to provide it, since there are concerns about fluid overload from intravenous administration and swallowing and choking from oral intake. But if attention to hydration could help improve outcomes, "it would be one of the easiest things in the world to do," Dr. Bahouth said at the meeting, which was sponsored by the American Heart Association.

The literature suggests a link between fluid status and stroke. Increased hemoglobin during acute stroke seems related to clinical deterioration after stroke, as does an elevated blood urea nitrogen (BUN)/creatinine ratio and serum osmolality. Dehydration means lower fluid volume in blood, which contributes to the prothrombotic state and puts shear stress on vessels, Dr. Bahouth said.

She retrospectively analyzed the records of 126 patients who presented with symptoms of acute stroke, with onset less than 12 hours from their last known normal function. In 44%, the BUN/creatinine ratio was more than 15 and urine specific gravity was greater than 1.010, indicating dehydration. All patients underwent MRI to determine infarct and perfusion volume. …

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