Association between electrolyte levels at presentation and hematoma expansion and outcome in spontaneous intracerebral hemorrhage: A systematic review

J Crit Care. 2021 Feb;61:177-185. doi: 10.1016/j.jcrc.2020.10.029. Epub 2020 Nov 3.


Purpose: To assess the association between specific electrolyte levels (sodium, potassium, calcium, magnesium, and phosphorus) on presentation and hematoma expansion (HE) and outcome in intracerebral hemorrhage (ICH).

Methods: This review was conducted in accordance with the PRISMA statement recommendations. Three databases were searched (Pubmed, Scopus, and Cochrane). Risk of bias was computed using the Newcastle-Ottawa Scale tool.

Results: 18 full-text articles were included in this systematic review including 10,385 ICH patients. Hypocalcemia was associated with worse short-term outcome in four studies, and two other studies were neutral. All studies investigating HE in hypocalcemia (n = 5) reported an association between low calcium level and HE. Hyponatremia (Na < 135 mEq/L) was shown to correlate with worse short-term outcome in two studies, and worse long-term outcome in one. There was one report showing no association between sodium level and HE. Hypomagnesemia was shown to be associated with worse short-term outcome in one study, while other reports were neutral. Studies evaluating hypophosphatemia or hypokalemia in ICH were limited, with no demonstrable significant effect on outcome.

Conclusion: This review suggests a significant association between hypocalcemia, hyponatremia and, of lesser degree, hypomagnesemia on admission and HE or worse outcome in ICH.

Keywords: Electrolytes; Hematoma expansion; Intracranial hemorrhage; Neurologic outcome.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Cerebral Hemorrhage
  • Electrolytes
  • Hematoma*
  • Humans
  • Hypocalcemia*
  • Sodium


  • Electrolytes
  • Sodium