Fluid and Electrolyte Management

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Key Points Hyponatremia is divided into subcategories according to tonicity, classified as isotonic, hypotonic, and hypertonic. SIADH and CSW are two forms of hypotonic hyponatremia commonly seen with CNS disease. While the clinical presentation overlaps, it is critical to distinguish the diagnosis as therapies differ significantly. Hypernatremia commonly results from an altered thirst mechanism and/or lack of water intake; however, its ability to cause cellular dehydration in brain tissue is often induced in certain neurologic populations. Hypokalemia has been associated with both an increase in stroke incidence and a poor outcome at 3 months. Hyperglycemia increases risk for the incidence of all stroke subtypes, hemorrhagic conversion of ischemic stroke, expanded hematoma volume in hemorrhagic stroke, and worse outcome after a stroke occurs. Stroke patients commonly experience acid–base disorders which may be a result of their injury or due to medications which can cause metabolic acidosis.

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