Hydration Practices for the Acute Stroke Patient in an Academic, Certified Stroke Center (P3.125)

Objective: To evaluate the hydration practices of acute stroke patients by physicians at a certified stroke center. Background: A large percentage of stroke patients present to the hospital dehydrated. Prior study suggested that patients who are dehydrated at the time of stroke presentation have more severe stroke type and potentially worse outcomes. Current acute stroke guidelines offer little in the way of recommendation for the management of fluid resuscitation. We suspected that stroke patients spend a significant portion of time NPO receiving little volume resuscitation. This study quantifies current hydration practices amongst cerebrovascular specialists at our certified stroke. Methods: Consecutive, acute ischemic stroke patients presenting to the hospital within 12 hours from symptom onset were evaluated over a 2 month period. We collected data regarding use of diuretics, stroke type and severity, cardiac function (ejection fraction), the time and method of fluid resuscitation. Results: Among 21 individuals meeting inclusion criteria, the average time to first fluid administration was 284 minutes (SD 217). Of those 4/21 (19%) received bolus of normal saline, 11/21 (52%) initiated maintenance intravenous fluid, and 6/21 (29%) received fluids by mouth. Average oral and intravenous fluid intakes over a 3 day stay were 2.8L and 3.7L respectively. Patients spent an average of 44 hours with NPO status for a variety of reasons including: completion of swallow examination, preparation for invasive procedure. 12/19 patient with labs drawn on the date of discharge had no change or worsening BUN/creatinine ratio suggestive of increased dehydration. This included 6/11(55%) who were dehydrated at time of admission. Conclusions: Although dehydration is common in the acute stroke population, initiation of fluid supplementation is delayed and many patients spend time without fluids. This provides a foundation for a system improvement project targeting time to fluid administration as well as the development of a fluid resuscitation algorithm for future prospective trials as we attempt to improve clinical outcome. Disclosure: Dr. Bahouth has nothing to disclose. Dr. Hillis has received research support from Allon Pharmaceutical. Dr. Gottesman has nothing to disclose.