Title:Electrolyte Imbalance and Neurologic Injury
Volume: 23
Issue: 7
Author(s): Jordan Poe, Sai Sriram, Yusuf Mehkri and Brandon Lucke-Wold*
Affiliation:
- Department of Neurosurgery, University of Florida, Gainesville, USA
Keywords:
Acute brain injury, electrolyte disturbance, clinical manifestations, supplementation, seizures, stroke.
Abstract: Neurologic injury continues to be a debilitating worldwide disease with high morbidity and
mortality. The systemic sequelae of a neural insult often lead to prolonged hospital stays and challenging
nutritional demands that contribute to poorer prognoses. Clinical management of a given condition
should prioritize preserving the homeostatic parameters disrupted by inflammatory response cascades
following the primary insult. This focused review examines the reciprocal relationship between electrolyte
disturbance and neurologic injury. A prolonged electrolyte imbalance can significantly impact
morbidity and mortality in neurologic injuries. A detailed overview of the major electrolytes and their
physiologic, iatrogenic, and therapeutic implications are included. The pathophysiology of how
dysnatremias, dyskalemias, dyscalcemias, and dysmagnesemias occur and the symptoms they can induce
are described. The manifestations in relation to traumatic brain injury, status epilepticus, and acute ischemic
stroke are addressed. Each type of injury and the strength of its association with a disruption in
either sodium, potassium, calcium, or magnesium is examined. The value of supplementation and replacement
is highlighted with an emphasis on the importance of early recognition in this patient population.
This review also looks at the current challenges associated with correcting imbalances in the
setting of different injuries, including the relevant indications and precautions for some of the available
therapeutic interventions. Based on the findings of this review, there may be a need for more distinct
clinical guidelines on managing different electrolyte imbalances depending on the specified neurologic
injury. Additional research and statistical data on individual associations between insult and
imbalance are needed to support this potential future call for context-based protocols.