From the Guidelines
Totilac is not a recognized medication for the treatment of stroke or hyponatremia, and its effects on serum sodium levels in stroke patients are unknown. However, based on the available evidence, it is crucial to monitor and manage serum sodium levels in stroke patients to prevent complications such as cerebral edema and osmotic demyelination syndrome. The most recent and highest quality study 1 emphasizes the importance of preventing hyponatremia in patients with cirrhosis, which may also be applicable to stroke patients, by maintaining blood sodium levels >135 mmol/L if possible and always >130 mmol/L. In the context of stroke management, the use of isotonic solutions such as 0.9% saline is recommended to avoid exacerbating ischemic brain edema, as stated in the guidelines for the early management of patients with acute ischemic stroke 1. Key considerations in managing serum sodium levels in stroke patients include:
- Monitoring serum sodium levels regularly
- Avoiding overly rapid correction of sodium levels (not exceeding 8-12 mEq/L in 24 hours)
- Using isotonic solutions for fluid management
- Maintaining euvolemia to prevent hypovolemia or hypervolemia, which can worsen outcomes in stroke patients. It is essential to note that the provided evidence does not directly address the effect of Totilac on serum sodium levels in stroke patients, and therefore, its use cannot be recommended based on the available information.
From the FDA Drug Label
ADVERSE REACTIONS ... Excessive dosage can lead to diarrhea with potential complications such as loss of fluids, hypokalemia, and hypernatremia. The effect of lactulose (Totilac) in stroke on serum sodium is an increased risk of hypernatremia due to excessive dosage leading to diarrhea and loss of fluids 2.
- Key points:
- Excessive dosage of lactulose can cause diarrhea
- Diarrhea can lead to loss of fluids
- Loss of fluids can cause hypernatremia
- Hypernatremia is an increase in serum sodium levels
From the Research
Effect of Totilac in Stroke on Serum Sodium
- There is no direct evidence in the provided studies to suggest the effect of Totilac in stroke on serum sodium.
- However, the studies discuss the importance of managing hyponatremia in stroke patients, as it is associated with worse outcomes and increased mortality 3, 4, 5.
- The causes of hyponatremia in stroke patients can be categorized into stroke-related and non-stroke-related causes, including syndrome of inappropriate antidiuretic hormone secretion, cerebral salt wasting, and underlying comorbidities 3, 4, 5.
- Treatment options for hyponatremia in stroke patients include fluid restriction, administration of hypertonic solution, loop diuretics, and vasopressin-receptor antagonists (vaptans) 3, 4.
- It is essential to note that overly rapid correction of hyponatremia can cause osmotic demyelination, a rare but severe neurological condition 6.
- The clinical spectrum of hyponatremia in patients with stroke can vary, and it is crucial to evaluate the underlying cause and type of stroke to guide management decisions 5.