What medication is used in stroke patients to promote fluid balance and maintain electrolyte levels?

From the Guidelines

For stroke patients requiring fluid management while preserving electrolytes, intravenous (IV) isotonic crystalloid solutions, such as 0.9% saline, are recommended. This approach is based on the guidelines for the early management of patients with acute ischemic stroke, which suggest that euvolemia is desirable to prevent hypoperfusion, renal impairment, and thrombosis, as well as to minimize the risk of ischemic brain edema and stress on the myocardium 1. The use of isotonic solutions like 0.9% saline is preferred because they are more evenly distributed into the extracellular spaces, including the intravascular space, which helps to maintain adequate hydration without exacerbating cerebral edema.

Key considerations for fluid management in stroke patients include:

• Initiating maintenance intravenous fluids for patients who are euvolemic at presentation, with daily fluid maintenance estimated as 30 mL per kilogram of body weight 1
• Rapidly replacing depleted intravascular volume followed by maintenance intravenous fluids for patients who are hypovolemic at presentation
• Avoiding hypotonic solutions, such as 5% dextrose or 0.45% saline, which can exacerbate ischemic brain edema
• Monitoring serum sodium and urea measurements to assess hydration status and plasma osmolality 1
• Adjusting fluid management strategies for patients with specific conditions, such as syndrome of inappropriate antidiuretic hormone secretion or fever, and for those who are vulnerable to intravascular volume overload, such as those with renal or heart failure.

From the FDA Drug Label

Potassium is the major cation of body cells (160 mEq/liter of intracellular water) and is concerned with the maintenance of body fluid composition and electrolyte balance. A deficiency of either potassium or chloride will lead to a deficit of the other.

The medication that pushes fluids and preserves electrolytes in a stroke patient is potassium chloride (IV), as it helps maintain body fluid composition and electrolyte balance 2.

• Key benefits:
  • Maintains body fluid composition
  • Preserves electrolyte balance
  • Critical in the regulation of nerve conduction and muscle contraction, particularly in the heart However, it is essential to use this medication with caution and follow the recommended dosage to avoid adverse reactions.

From the Research

Medication for Stroke Patients

To manage stroke patients, it is crucial to maintain proper hydration and electrolyte balance. The following points highlight the importance of fluid and electrolyte management in stroke patients:

• Proper hydration is essential for better recovery in patients after stroke 3
• Inadequate fluid intake is common in stroke patients, with 41.2% of patients not meeting the recommended fluid intake 3
• Insufficient energy intake is also prevalent, with 95.6% of patients not meeting the minimum suggested amount 3

Electrolyte Balance

Electrolyte changes are common in stroke patients, with hyponatremia being almost equally common in both hemorrhagic and ischemic stroke patients 4. The study found that:

• Hyponatremia is more common than hypernatremia in both groups
• Hypokalemia is almost equally common in both hemorrhagic and ischemic stroke patients
• Hypochloremia is more common than hyperchloremia in both groups

Serum Potassium Levels

Serum potassium levels have been found to be positively associated with stroke and mortality in a large population-based cohort 5. The study found that:

• There is an independent, linear association between serum potassium and both stroke and mortality
• This association is significant in subjects both older and younger than the median age
• The association is positive and significant for both ischemic stroke and intracerebral hemorrhage, and in both hypertensive and normotensive subjects

Management of Stroke Patients

The management of stroke patients involves early identification and triage to centers capable of delivering appropriate treatment, as well as management of patient physiologic parameters to minimize infarct volumes 6. The following points highlight the importance of early management:

• Early identification of patients with stroke and triage to centers capable of delivering appropriate treatment is crucial
• Management of patient physiologic parameters, including fluid and electrolyte balance, is essential to minimize infarct volumes
• Protocols for management of patient physiologic parameters, including use of emergency medical services protocols, are important for improving patient outcomes 7, 6