Subarachnoid hemorrhage

[superana]

I'm wondering if anyone can explain to me why so many patients with a subarachnoid hemorrhage present with elevated glucose, sodium and chloride levels.

[Esme12, ASN, BSN, RN]

Simply put.......the stress placed on the auto-regulating mechanisms by the insult/injury to the brain and it's attempts at trying to "fix itself" and decrease the cerebral edema causes shifts in fluids, anti-diruetic hormone and electrolyte imbalances in the ADH/sodium pump regulatory mechanisms.....for a detailed, in depth explanation

SODIUM BALANCE

[superana]

Thank you!!! :)

[nurseprnRN, BSN, RN]

It might not be the bleed that causes the electrolyte imbalance. Sometimes it's the other way around. They have a water deficit.

Sometimes, if your serum sodium and glucose are really high (severe water deficit, think hyperosmolar nonketotic, all that glucose pulls water out thru the kidneys, remember the polyuria in uncontrolled diabetes?), the increased serum osmolarity will pull so much water out of your cells (including your brain cells) that the tissues shrink. Brain tissues shrink -> tear meninges -> subarachnoid bleed. Just another fun thing to think about when your patient has a serum glucose of 800 and a serum Na+ of 168.