DOI: http://dx.doi.org/10.18203/2349-3933.ijam20181446

Clinical profiles, electrolytes status in acute strokes and their outcome

Butungeshwar Pradhan, Chakradhar Majhi, Sunil K. Panigrahi

Abstract


 

Background: Intracerebral hemorrhage (ICH) and Ischemic strokes (ISCHS) can occurs along with many metabolic abnormalities in acute stage. Electrolyte disturbances can occurs in acute stage of strokes due to many causes. The aim of the present study is to observe the clinical profiles, electrolytes status in acute stage of strokes and their outcome.

Methods: One hundred stroke patients diagnosed clinically and confirmed by CT or MRI within 24 hours of onset were consecutively selected for the study after fulfillment of inclusion criteria in the indoor department of medicine, VSSIMSAR, Burla, Odisha (India), from Nov 2015 to Nov 2017. Baseline Glasgow Coma Scale (GCS), serum electrolytes were estimated along with other biochemical tests as needed. Glasgow Outcome Scale (GOS) was determined after 5th day of strokes.  Data were collected and analyzed.  

Results: Hyponatraemia present in 13 (36.11%) of ICH and 6 (2.38%) ISCHS. Hypokalaemia was present in 7 (9.44%) of ICH and 11(17.19%) ISCHS. Hypocalcaemia was present in 3 (8.33%) of ICH and 18(28.12%) ISCHS. (P 0.0001). Hypomagnesaemia in 2(5.56%) ICH and 21 (32.81%) ISCHS. (P 0.0001). Minor GCS in 38 (62.29%), moderate 15 (24.59%) and severe 8(13.12%) patients with dyselectrolytemia versus 31 (79.48%), 5 (12.82%) and 3 (7.7%) with normal electrolytes respectively. GOS was good in 30 (49.18%), poor 18 (29.51%) and GOS 1 (Deaths) 13 (21.31%) versus 32(82.05%), 5(12.82%) and 1(1.3%) in patients with normal electrolytes status. (P 0.03).

Conclusions: E Hyponatraemia and hypoklaemia was very often present in ICH and hypocalcaemia and hypomagnesaemia in ISCHS, Higher rates of morbidity and mortalities was associated with dyselectrolytemia.


Keywords


Electrolytes status, Glasgow coma scale, Glasgow outcome scale, Strokes

Full Text:

PDF

References


Smith W.S: Cerebrovascular diseases in: Harrison’s Principle of Internal Medicine.19th Ed, Mc-Graw Hill Companies;New York City. 2015; 2559.

Monica W. Project Investigators. The world Health Organization MONICA Project (monitoring trends and determinant in cardiovascular diseases). J Cli Epidemiol;1988,41(2):105-14.

World Health Organization. (2014). The top 10 causes of deaths. Available at http://www.who.int/mediacentre/factsheets/fs310/en/

Langhorne P, Stott DJ, Robertson et al. Medical complications after stroke: a multicenter study. Stroke.2000; 31(6):1223-29.

Summers D, Leonard A, Wentworth D et al. Comprehensive overview of Nursing and Interdisciplinary care of the acute ischemic stroke patients. A scientific statement from the American Heart Association.Stroke.2009;40(8):2911-44.

WHO STEPS Stroke Manual: The WHO STEP wise approach to stroke surveillance. STEPS Stroke Surveil Man. 2006;2(1):5-9.

Broderick J, Connolly S, Feldmann E, Hanley D, Kase C, Krieger D, Mayberg M, Morgenstern L, Ogilvy CS, Vespa P, Zuccarello M. REPRINT. Circulation. 2007;116(16):e391-413.

Stern RH. Severe symptomatic hyponatraemia. Treatment and outcome. A study of 64 cases. Ann Int Med.1987;107(6):656-64.

Coleman HA, Tare M, Tare M, Porkington HC. Endothelial potassium channels, endothelium-dependent hyperpolarisation and the regulation of vascular tone in health and disease. Cli Exp Pharmcol Physiol. 2004;31(9):641e9.

Simond JM, Tarasov KV, Gerzanich V: Non-selective cation channels, treatment receptor potential channels and ischemic stroke. Biochem Biophys Acta. 2007;1772(8):247-957.

Macdonald JF, Xiong ZG, Jackson MF: Paradox of Ca++ signalling, cell death and stroke. Trends NeuroSci.2006;29(2):75-81.

Bandopadhyay M, Jatua SK, Adhikari M, Bhandari A. A study of electrolyte Abnormality in acute stroke. Annals Int Med Dental Res. 2017:3(5):4-9.

Siddiqui MR, Islam QT, Haque MA, Iqbal MJ, Hossain A, Rahman YU, et al. Electrolyte status in different types of acute strokes patients and their correlation with some common clinical presentation Medicine.2012;13(2):133-7.

Hassan MK, Hassan AB, Rubaiyat KA. Electrolyte disturbances in acute phases of stroke patients. Dinajpur Med Col J. 2013;91:12-6.

Huang WY, Weng WC, Peng TI, Chien YY, Wu CL, Lee M. et al. Association of hyponatraemia in acute stroke stage with Three-year mortality in patients with first ever ischemic stroke. Cerebrovascular Dis. 2012;34(1):55-60.

Rodriguez B, Staff, Fortunato G, Mccullougha D et al. Hyponatraemia in the prognosis of acute ischemic stroke. J stroke Cerebrovascular Dis. 2014;23(5):850-4.

Natarajan K, Md Flicp, Mitra P. “Hyponatraemia in stroke”:Cerebral salt wasting versus syndrome of inappropriate anti-diuresis. IOSR J Dent Med Sci. 2016;15(7):1-22

Gariballa SE, Robinson TG, Fotherlay MD: Hypokalaemia and potassium excretion in stroke patients. J Am Geriator Soc. 1997;45(12):1454-58.

Haider A, Hussan Hasan A, All-Hamadani, Munther TH: The relation of hypokalaemia to Hypertensive and Non-hypertensive Ischemic Stroke. Iraqi J Med Sci. 2014;12(2):1681-6579

Gao F, Wang CT, Chen C, Guo X, Yang LH, Ma XC, Han JF. Effect of hypokalaemia on functional outcome at 3 months post-stroke among first ever acute ischemic stroke patients. Med Sci Monit. 2017;23:2825-32.

Gupta A, Dubey U, Arvind K, Singh S. Correlation of calcium levels with severity and functional outcome in acute ischemic stroke patients. Int J Res Med Sci. 2015;3(12):3698-702.

Jong Won Chug, Wi-Sun Ruy, Beom Toon Kim. Elevated calcium after acute ischemic stroke: Association with a poor short-term outcome and long-term mortality: J Stroke. 2015;17(1):54-9.

Morotti A, Charidimus A, Chin-ling P, Michael J, Jessel BS, Kristin S. Association between serum calcium levels and extent of bleeding in patients with intracranial haemorrhage. JAMA Neurol. 2016; 73(11):1285-90.

Khalid MK, Faiza N, Rashid I, Hussain ZS, Rashid A, Noorman. To determine the frequency of hypomagnesaemia among patients with acute ischemic stroke and to study the correlation of serum magnesium with modified Rankin scale after acute ischemic stroke. 2015;9(4):1240.

Ghayyur a, hussain SS, butt A, shahid S, Asif HH, Nisar S. Risk factors of hypomagnesemia in patients with acute ischemic stroke (ais): a cross sectional study of a tertiary care hospital, lahore pakistan during 2015. Fuuast J biol. 2017;7(1).24-32.