Risks of diuretic usage following stroke.
OBJECTIVE
To assess the effects of diuretic use on hydration status following stroke.


METHODS
Admission serum hydration markers and neurologic assessments were prospectively recorded for 296 stroke rehabilitation inpatients with stable renal function. Dysphagia was defined by bedside dysphagia evaluation and subsequent modified barium swallow, if necessary. Serum hydration markers were checked at approximate 10-day intervals. Analysis of variance was used to test the effects of clinical variables on serum markers for hydration during the rehabilitation hospital stay. Odds ratios were used to quantify the risks of developing a blood urea nitrogen value > or = 45 mg/dl.


RESULTS
The mean peak blood urea nitrogen associated with each of the following were diuretic usage yes/no (33 mg/dl +/- 18/26 +/- 17, P < 0.01), dysphagia yes/no (32 +/- 21/25 +/- 14, P < 0.001), and need for thin-liquid restriction yes/no (34 +/- 20/25 +/- 15, P < 0.001). The odds ratio for developing a peak blood urea nitrogen > or = 45 for patients taking a diuretic with evidence of penetration or aspiration documented by modified barium swallow was (19.8, P < 0.001). The odds ratio for developing a peak blood urea nitrogen > or = 45 for those taking a diuretic who needed thin-liquid restriction was (4.8, P = 0.004).


CONCLUSIONS
Diuretic usage was associated with a significant increase in peak blood urea nitrogen across the entire stroke study sample. The highest odds ratio for developing a peak blood urea nitrogen > or = 45 was 19.8 for patients taking a diuretic who had dysphagia plus modified barium swallow evidence of penetration-aspiration.
Churchill
Matthew
M
Burke Rehabilitation Hospital, 785 Mamaroneck Avenue, White Plains, NY 10605. mreding@burke.org
Grimm
Sean
S
Reding
Michael
M
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001806:Blood Urea Nitrogen; D003680:Deglutition Disorders / Q000209:etiology*; D003681:Dehydration / Q000139:chemically induced*; D004232:Diuretics / Q000009:adverse effects*; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications* / Q000378:metabolism*; D000071939:Stroke Rehabilitation
D004232:Diuretics