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Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist

Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying como...

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Autores principales: Yuen, Kevin C J, Sharf, Valerie, Smith, Elizabeth, Kim, Minhwan, Yuen, Alissya S M, MacDonald, Paul R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240457/
https://www.ncbi.nlm.nih.gov/pubmed/34969834
http://dx.doi.org/10.1136/svn-2021-001230
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author Yuen, Kevin C J
Sharf, Valerie
Smith, Elizabeth
Kim, Minhwan
Yuen, Alissya S M
MacDonald, Paul R
author_facet Yuen, Kevin C J
Sharf, Valerie
Smith, Elizabeth
Kim, Minhwan
Yuen, Alissya S M
MacDonald, Paul R
author_sort Yuen, Kevin C J
collection PubMed
description Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying comorbidities and concomitant medications. Additionally, hospitalised patients who had an acute stroke may receive excessive intravenous hypotonic solutions, have poor fluid intake due to impaired neurocognition and consciousness, may develop sepsis or are administered drugs (eg, mannitol); factors that can further alter serum sodium levels. Sodium and water perturbations can also be exacerbated by the development of endocrine consequences after an acute stroke, including secondary adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus. Recently, COVID-19 infection has been reported to increase the risk of development of sodium and water perturbations that may further worsen the outcomes of patients who had an acute stroke. Because there are currently no accepted consensus guidelines on the management of sodium and water perturbations in patients who had an acute stroke, we conducted a systematic review of the literature published in English and in peer-reviewed journals between January 2000 and December 2020, according to PRISMA guidelines, to assess on the current knowledge and clinical practices of this condition. In this review, we discuss the signs and symptoms of hyponatraemia and hypernatraemia, the pathogenesis of hyponatraemia and hypernatraemia, their clinical relevance, and we provide our recommendations for effective treatment strategies for the neurologist in the management of sodium and water perturbations in commonly encountered aetiologies of patients who had an acute stroke.
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spelling pubmed-92404572022-07-20 Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist Yuen, Kevin C J Sharf, Valerie Smith, Elizabeth Kim, Minhwan Yuen, Alissya S M MacDonald, Paul R Stroke Vasc Neurol Review Sodium and water perturbations, manifesting as hyponatraemia and hypernatraemia, are common in patients who had an acute stroke, and are associated with worse outcomes and increased mortality. Other non-stroke-related causes of sodium and water perturbations in these patients include underlying comorbidities and concomitant medications. Additionally, hospitalised patients who had an acute stroke may receive excessive intravenous hypotonic solutions, have poor fluid intake due to impaired neurocognition and consciousness, may develop sepsis or are administered drugs (eg, mannitol); factors that can further alter serum sodium levels. Sodium and water perturbations can also be exacerbated by the development of endocrine consequences after an acute stroke, including secondary adrenal insufficiency, syndrome of inappropriate antidiuretic hormone secretion and diabetes insipidus. Recently, COVID-19 infection has been reported to increase the risk of development of sodium and water perturbations that may further worsen the outcomes of patients who had an acute stroke. Because there are currently no accepted consensus guidelines on the management of sodium and water perturbations in patients who had an acute stroke, we conducted a systematic review of the literature published in English and in peer-reviewed journals between January 2000 and December 2020, according to PRISMA guidelines, to assess on the current knowledge and clinical practices of this condition. In this review, we discuss the signs and symptoms of hyponatraemia and hypernatraemia, the pathogenesis of hyponatraemia and hypernatraemia, their clinical relevance, and we provide our recommendations for effective treatment strategies for the neurologist in the management of sodium and water perturbations in commonly encountered aetiologies of patients who had an acute stroke. BMJ Publishing Group 2021-12-30 /pmc/articles/PMC9240457/ /pubmed/34969834 http://dx.doi.org/10.1136/svn-2021-001230 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Review
Yuen, Kevin C J
Sharf, Valerie
Smith, Elizabeth
Kim, Minhwan
Yuen, Alissya S M
MacDonald, Paul R
Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title_full Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title_fullStr Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title_full_unstemmed Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title_short Sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
title_sort sodium and water perturbations in patients who had an acute stroke: clinical relevance and management strategies for the neurologist
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9240457/
https://www.ncbi.nlm.nih.gov/pubmed/34969834
http://dx.doi.org/10.1136/svn-2021-001230
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