Abstract
ObjectiveThe goal of the study was to determine the percentage of hyperchloremia in patients who died in medical intensive care unit (ICU) and thus emphasizing the need of avoiding chloride-rich solutions due to their deleterious effects.Study designWe conducted a retrospective study of data from 206 patients who expired in medical ICU in one year from January 2017 to December 2017 in the department of critical care medicine at Shifa International Hospital, Islamabad.Material and methodsThe study included 206 patients: 93 (43.1%) men and 123 (56.9%) women, over the age of 18 years who expired in medical ICU in one year from January 2017 to December 2017. Patients included for the study were all those who expired with any diagnosis but those who remained admitted in ICU for at least 72 hours and received intravenous fluids. The serum chloride levels of the patients at the time of admission and at 72 hours of stay in ICU were collected. The patients who were having serum chloride levels of 107 milliequivalent per deciliter (meq/dl) or more were labeled as having hyperchloremia. The data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Crop., Armonk, NY, USA). The mean and standard deviations were calculated for continuous variables while frequency and percentages were calculated for qualitative variables.ResultsAmong 206 patients who expired in our ICU, 109 (50.5%) patients had hyperchloremia at 72 hours of admission in ICU while 107 (49.5%) patients did not had hyperchloremia. Hyperchloremia was more frequent in patients with sepsis or septic shock.ConclusionHigher percentage (50.5%) of hyperchloremia at 72 hours of admission among patients (who expired in our medical ICU) indicates excessive use of chloride-rich intravenous fluids. This finding may have significant impact on mortality along with other contributing factors that lead to death of the patients. Keeping in view the findings of the study, chloride-rich solutions should be used carefully to counter the effects of hyperchloremia in patients requiring large volume fluid resuscitation in ICU. Fluids with lower content of chloride such as lactated ringer may be equally good in large volume fluid resuscitation with advantage of avoiding hyperchloremia.
Highlights
Chloride is one of the most important and the most abundant anion in the extracellular fluid contributing approximately one-third extracellular fluid tonicity [1]
Patients included for the study were all those who expired with any diagnosis but those who remained admitted in intensive care unit (ICU) for at least 72 hours and received intravenous fluids
Among 206 patients who expired in our ICU, 109 (50.5%) patients had hyperchloremia at 72 hours of admission in ICU while 107 (49.5%) patients did not had hyperchloremia
Summary
Chloride is one of the most important and the most abundant anion in the extracellular fluid contributing approximately one-third extracellular fluid tonicity [1]. Chloride plays several physiologically important roles in the body which include acid-base balance, immune modulation, osmosis and muscular activity [2]. Acid base homeostasis is the main function, chloride plays in the body. Chloride levels are inversely related to bicarbonate which is thought to be the major buffer in human body. Increasing or decreasing levels of chloride have direct impact on acid base status, resulting in non-anion gap metabolic acidosis and metabolic alkalosis, respectively. How to cite this article Shad Z, Qureshi M, Qadeer A, et al (May 28, 2019) Hyperchloremia in Intensive Care Unit Mortality: An Underestimated Fact.
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