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Fluid and Electrolyte Management

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Book cover Handbook of Clinical Nutrition and Stroke

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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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Abbreviations

ADH:

Antidiuretic Hormone

CDI:

Central Diabetes Insipidus

CSW:

Cerebral Salt Wasting

DI:

Diabetes Insipidus

dDAVP:

Desmopressin

NDI:

Nephrogenic Diabetes Insipidus

SIADH:

Syndrome of Inappropriate Antiduiretic Hormone

tPA:

tissue Plasminogen Activator

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Authors and Affiliations

  1. Neurological Intensive Care Unit, Cleveland Clinic, 9500 Euclid Avenue, Unit H22, Cleveland, OH, USA

    Melissa Ellis M.S.N., A.C.N.P.-B.C. & Tina S. Resser M.S.N., A.C.N.P.-B.C., C.N.R.N.

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  1. Melissa Ellis M.S.N., A.C.N.P.-B.C.
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Correspondence to Tina S. Resser M.S.N., A.C.N.P.-B.C., C.N.R.N. .

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Editors and Affiliations

  1. , Nutrition Support Team, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, 44195, Ohio, USA

    Mandy L. Corrigan

  2. , Nutrition Therapy, Cleveland Clinic, 9500 Euclid Ave. M17, Cleveland, 44195, Ohio, USA

    Arlene A. Escuro

  3. Center for Human Nutrition, Department of Gastroenterology, Cleveland Clinic, 9500 Euclid Ave. A51, Cleveland, 44195, Ohio, USA

    Donald F. Kirby

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Ellis, M., Resser, T.S. (2013). Fluid and Electrolyte Management. In: Corrigan, M., Escuro, A., Kirby, D. (eds) Handbook of Clinical Nutrition and Stroke. Nutrition and Health. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-62703-380-0_12

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