Abstract
Over the past few years, chloride has joined the league of essential electrolytes for critically ill patients. Dyschloremia can occur secondary to various etiologic factors before and during patient admission in the intensive care unit. Some cases are disease-related; others, treatment-related. Chloride abnormalities were shown in animal models to have adverse effects on arterial blood pressure, renal blood flow, and inflammatory markers, which have led to several clinical investigations. Hyperchloremia was studied in several settings and correlated to different outcomes, including death and acute kidney injury. Baseline hypochloremia, to a much lesser extent, has been studied and associated with similar outcomes. The chloride content of resuscitation fluids was also a subject of clinical research. In this review, we describe the effect of dyschloremia on outcomes in critically ill patients. We review the major studies assessing the chloride content of resuscitation fluids in the critically ill patient.
Highlights
Chloride constitutes 70% of the negative ion content of the body[1,2]
High chloride concentration was associated with increased renal vasoconstriction and reductions in renal blood flow and glomerular filtration rate[7,8]. These findings have led to growing interest in the interplay of chloride and its effect for the critically ill patient. Both hypochloremia and hyperchloremia have been associated with worse clinical outcomes, including death and acute kidney injury (AKI)
Yunos and colleagues[29] performed a prospective, open-label, sequential period trial showing that the use of chloride-restrictive intravascular fluid strategy for resuscitation, versus a chloride-rich strategy, reduced AKI incidence and the need for renal replacement therapy (RRT) among intensive care unit (ICU) patients
Summary
Chloride constitutes 70% of the negative ion content of the body[1,2]. The principal dietary chloride intake is in the form of salt and nutritional deficiencies of chloride are rare[3]. These findings have led to growing interest in the interplay of chloride and its effect for the critically ill patient Both hypochloremia and hyperchloremia have been associated with worse clinical outcomes, including death and acute kidney injury (AKI). Yunos and colleagues[29] performed a prospective, open-label, sequential period trial showing that the use of chloride-restrictive intravascular fluid strategy for resuscitation, versus a chloride-rich strategy, reduced AKI incidence and the need for renal replacement therapy (RRT) among ICU patients. The research arm receiving the balanced crystalloid had less hyperchloremia and acidosis and required fewer catecholamines These trials raised concerns about the potential harmful associations with the use of chloride-rich solutions. More than 60% of patients in the chloride-restricted strategy developed hyperchloremia
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