Severe hypoxia causes rapid depolarization of CA1 neurons and glial cells that resembles spreading depression (SD). In brain slices in vitro, the SD-like depolarization and the associated irreversible loss of function can be postponed, but not prevented, by blockade of Na+ currents by tetrodotoxin (TTX). To investigate the role of Na+ flux, we made recordings from the CA1 region in hippocampal slices in the presence and absence of TTX. We measured membrane changes in single CA1 pyramidal neurons simultaneously with extracellular DC potential ( V o) and either extracellular [K+] or [Na+]; alternatively, we simultaneously recorded [Na+]o, [K+]o, and V o. Confirming previous reports, early during hypoxia, before SD onset, [K+]o began to rise, whereas [Na+]o still remained normal and V o showed a slight, gradual, negative shift; neurons first hyperpolarized and then began to gradually depolarize. The SD-like abrupt negative Δ V ocorresponded to a near complete depolarization of pyramidal neurons and an 89% decrease in input resistance. [K+]oincreased by 47 mM and [Na+]o dropped by 91 mM. Changes in intracellular Na+ and K+concentrations, estimated on the basis of the measured extracellular ion levels and the relative volume fractions of the neuronal, glial, and extracellular compartment, were much more moderate. Because [Na+]o dropped more than [K+]o increased, simple exchange of Na+ for K+ cannot account for these ionic changes. The apparent imbalance of charge could be made up by Cl− influx into neurons paralleling Na+ flux and release of Mg2+ from cells. The hypoxia-induced changes in interneurons resembled those observed in pyramidal neurons. Astrocytes responded with an initial slow depolarization as [K+]o rose. It was followed by a rapid but incomplete depolarization as soon as SD occurred, which could be accounted for by the reduced ratio, [K+]i/[K+]o. TTX (1 μM) markedly postponed SD, but the SD-related changes in [K+]o and [Na+]owere only reduced by 23 and 12%, respectively. In TTX-treated pyramidal neurons, the delayed SD-like depolarization took off from a more positive level, but the final depolarized intracellular potential and input resistance were not different from control. We conclude that TTX-sensitive channels mediate only a fraction of the Na+influx, and that some of the K+ is released in exchange for Na+. Even though TTX-sensitive Na+ currents are not essential for the self-regenerative membrane changes during hypoxic SD, in control solutions their activation may trigger the transition from gradual to rapid depolarization of neurons, thereby synchronizing the SD-like event.