In this episode, I’ll discuss why hypotonic or dextrose-based solutions are avoided in patients with acute ischemic stroke.
A common cause of in-hospital death from acute ischemic stroke is brain edema and elevated intracranial pressure. This is often a result of occlusion of the major intracranial arteries or multi-lobar stroke. Brain edema is thought to peak somewhere between 3 and 5 days after the initial ischemic event.
Administration of a hypo-osmolar fluid such as 5% dextrose or half normal saline carries a theoretical risk of increasing the severity of cerebral edema. The proposed mechanism is by creating an osmotic gradient that would shift free water across the blood-brain barrier to balance out the hypo-osmolar effects of these solutions in the plasma.
Although this is a theoretical risk, there is usually not a compelling reason to take the chance of giving a hypo-osmolar IV solution to patients with acute ischemic stroke, and common practice is to avoid such solutions in these patients.
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