A comparative study of serum electrolytes and lipid levels in ischaemic and haemorrhagic stroke

Vinod V. Wali, Smita S. Patil


Background: Stroke or cerebrovasular accident is a major cause of disability worldwide and the second most common cause of death after ischaemic heart disease. There has been a steady increase in incidence of stroke; recent data shows that stroke incidence decreased by 42% in high-income countries and by 100% in low to middle income countries. Aim of the study was to know the association of serum electrolytes and lipid levels in stroke.

Methods: This was a retrospective study conducted in June 2014 at tertiary care hospital in South India. Data was obtained from the medical records departments from June 2011 to August 2012. An adult Treatment Panel III criterion was used to classify plasma lipid levels. The serum urea, serum creatinine, serum electrolytes and urinary electrolyte levels were measured by flame photometry. Descriptive statistics has been carried out in the present study. Student ‘t’ test used to test the significance, between the groups and P value of <0.05 were considered as moderately significant, P values of <0.01 was considered highly significant.

Results: There was no statistically significant difference in electrolyte levels between ischaemic and haemorrhagic stroke patients. Most common electrolyte imbalance in ischaemic stroke was hyponatremia and most common electrolyte imbalance in Haemorrhagic stroke was hypokalemia. Statistically significant alteration were seen in total cholesterol, LDL and VLDL levels between haemorrhagic and ischaemic stroke.

Conclusions: In the present study total cholesterol and HDL levels were higher in haemorrhagic stroke whereas triglycerides, LDL and VLDL were high in ischaemic stroke. Regular monitoring of lipid levels in patients with high risk factors for stroke patients will help in decreasing the mortality and morbidity. Future studies should be prospective, multi-centric and include a large sample size which will help in determining the association between electrolytes and lipid levels in stroke patients.


Electrolytes, Haemorrhagic stroke, Ischaemic stroke, Lipid parameters

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Donnan GA, Fisher M, Macleod M, Davis SM. Stroke. The Lancet. 2008;371(9624):1612-23.

Van der Worp HB, Van Gijn J. Acute Ischaemic Stroke. N Eng J Med. 2007;357:572-9.

Feigin VL, Lawes CM, Bennett DA, Barker-Collo SL, Parag V. Worldwide stroke incidence and early case fatality reported in 56 population-based studies: A systematic review. The Lancet Neurol. 2009;8(4):355-69.

Navarro JC, Bitanga E, Suwanwela N, Chang HM, Ryu SJ, Huang YN, Wong L, et al. Complication of acute stroke: A study in ten Asian countries. Neurology Asia. 2008;13:33-9.

Kusuda K, Saku Y, Sadoshima S, Kozo I, Fujishima M. Disturbances of fluid and electrolyte balance in patients with acute stroke. Nihon Ronen Igakkai Zasshi. 1989;26:223-7.

Coenraad MJ, Meinders AE, Tall JC, Bolk JH. Review Hyponatraemia in intracranial disorders. Netherlands J Med. 2001:58;123-7.

Roy KS, Bandyopadhyay R, Paul R, Chakraborty S, Ray D, Mitra S, et al. Study on serum and urinary electrolyte changes in cerebrovascular accident. JIACM. 2014;15(2):91-5.

Tilvis RS, Erkinjuntti T, Sulkava R, Färkkilä M, Miettinen TA. Serum lipids and fatty acids in ischemic strokes. Am Heart J. 1987;113:615-9.

Lindenstrom E, Boysen G, Nyboe J. Influence of total cholesterol, high density lipoprotein cholesterol and triglycerides on risk of cerebrovascular disease: the Copenhagen City Heart Study. BMJ. 1994;309:11-5.

Hart RG, Sherman DG, Miller VT, Easton JD. Diagnosis and management of ischemic stroke: Selected controversies. Curr Probl Cardiol. 1983;8:43-53.

Adams HP, Butler MJ, Biller J, Toffal GJ. Nonhemorrhagic cerebral infarction in young adults. Arch Neurol. 1986;43:793-6.

Klein GM, Seland TP. Occlusive cerebrovascular disease in young adults. Can J Neurol Sci. 1984;11:302-4.

Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486-97.

Friedwald WT, Levy RL, Fredrickson DS. Estimation of the concentration of low density lipoprotein Cholesterol in plasma without use of the preparative ultracentrifuge. Clinical chemistry. 1972;18(6):499-502.

Kurzke JF. Epidemiology of cerebrovascular disease. In:P.Rowland L, editor. Merrtt’s Neurology. Philadelphia:LL W;2000:135-76.

Siddique MR, Islam QT, Haque MA, Iqbal MJ, Hossain A, Rahman YU, et al. Dys-electrolytaemia in Acute Stroke Patient, An Observational Study, Bangladesh J Medicine. 2011;22:30-4.

Badiuzzaman M, Mohammed FR, Chowdhury FR, Bari MS, Alam MB, Ahasan HN, et al. Prevalence of Modifiable risk factors among Stroke patients in a tertiary care Hospital in Dhaka; J Medicine. 2009;10:18-21.

Ziai WC, Mirski MA, Bhardwaj A. Use of hypertonic saline in ischaemic stroke. Stroke. 2002;33:1166-7.

Hasan MK, Hasan AB, Rubaiyat KA. Electrolyte Disturbances in Acute Phase of Stroke Patients. Dinajpur Med Col J. 2013;6(1):12-6.

Chakraborty S, Ghosh K, Hazra R, Biswas RN, Ghosh S, Bhattacharya A, et al. Serum and Urinary Electrolyte Levels in Cerebro-Vascular Accident Patients: A Cross Sectional Study. American J Inter Med. 2013;1 (4):36-9.

Moussa NA, Osman AR, Yahya TM. Acute hyponatremic encephalopathy after a cerebrovascular accident. Am J Med Sci. 1998;316:56-9.

Stolarz-Skrzypek K, Kuznetsova T, Thijs L, Tikhonoff V, Seidlerová J, Richart T, et al. Fatal and nonfatal outcomes, incidence of hypertension, and blood pressure changes in relation to urinary sodium excretion. JAMA. 2011:305(17):1777-85.

Tobian L, Lange JM, Ulm KM, Wold LJ, Iwai J. Potassium prevents death from strokes in hypertensive rats without lowering blood pressure. J Hypertens Suppl. 1984;2(3):363-6.

Tobian L. High potassium diets markedly protect against stroke deaths and kidney disease in hypertensive rats, a possible legacy from prehistoric times. Can J Physiol Pharmacol. 1986;64(6):840-8.

Sudlow CLM, Warlow CP. Comparable studies of the incidence of stroke and its pathological types. R esults from an international collaboration. Stroke. 1997;28:491-9.

Frank JW, Reed DM, Grove JS, Benfante R. will lowering population level of serum cholesterol affects total mortality. J Clin Epidemiol. 1992;45:333-46.

Khan NI, Naz L, Mush taq S, Rukh L, Ali S, Hussain Z. Ischemic stroke: prevalence of modifiable risk factors in male and female patients in Pakistan. Pak J Pharm Sci. 2009;22:62-7.

Prospective studies collaboration group. Cholesterol, diastolic blood pressure, and stroke: 13,000 strokes in 450,000 people in 45 prospective cohorts. Lancet. 1995;346:1647-53.

The American Stroke Association. Guidelines for Prevention of Stroke in Patients with stroke or Transient Ischemic Attack. Stroke. 2006;37:577-617.

Hachinski V1, Graffagnino C, Beaudry M, Bernier G, Buck C, Donner A, et al. Lipids and stroke: A pardox resolved. Arch Neurol 1996;53:303-7.

Kim SJ, Park YG, Kim JH, Han YK, Cho HK, Bank OY. Plasma fasting and non-fasting triglycerides and high density lipoprotein cholesterol in atherosclerotic stroke: different profiles according to low-density lipopreotein cholesterol. Atherosclerosis. 2012;223(2):463-7.

Simons LA, McCallum J, Friedlander Y, Simons J. Risk factors for ischemic stroke: Dubbo study of the elderly. Stroke 1998;29:1341-6.

Bowman TS, Sesso HD, Ma J, Kurth T, Kase CS, Stampfer MJ, et al. Cholesterol and the risk of ischemic stroke. Stroke. 2003;34:2930-4.

Russman AN, Schultz LR, Zaman IF, Rehman MF, Silver B, Mitsias P, et al. A significant temporal and quantitative relationship exists between high-density lipoprotein levels and acute ischaemic stroke presentation. J Neurol Sci. 2009;279:53-6.

Fahimfar N, Khalili D, Mohebi R, Azizi F, Hadaegh F. Risk factors for ischaemic stroke; results from 9 years of follow-up in a population based cohort of Iran. BMC Neurology. 2012;12:117.