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Daily Intravenous Chloride Load and the Acid‐Base and Biochemical Status of Intensive Care Unit Patients
Author(s) -
Klemz Katja,
Ho Lisa,
Bellomo Rinaldo
Publication year - 2008
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2008.tb00393.x
Subject(s) - medicine , intensive care unit , chloride , bicarbonate , acid–base homeostasis , morning , intensive care , acidosis , metabolic acidosis , sodium bicarbonate , serum chloride , anesthesia , sodium , intensive care medicine , chemistry , organic chemistry
Background Studies have described the development of metabolic acidosis after the rapid intravenous administration of large amounts of chloride‐rich solutions. There are little data on the effect of daily intravenous fluid therapy within the intensive care unit. Aim To test the correlation between daily intravenous chloride load and the acid‐base and biochemical status of intensive care unit patients. Method Data were prospectively collected on the type and volume of intravenous fluids administered to intensive care unit patients over 24–hour cycles. Correlation was then tested between daily chloride load and the acid‐base and biochemical variables obtained from the first morning measurement of arterial blood gases on the following day. Results 49 patients were audited. 30 (61%) patients had hyperchloraemia on intensive care unit admission with a median serum chloride level of 108 mmol/L (range 87–123); 32 (65%) patients had a negative base excess above −2 mEq/L and 11 (23%) patients had a bicarbonate level below 22 mmol/L. The median daily amount of chloride administered was 88.5 mmol (range 0–732). There was a statistically significant negative correlation between total chloride intake and serum bicarbonate (p < 0.0002), base excess (p < 0.0002), pH (p < 0.006), sodium chloride difference (p < 0.0001) and a positive correlation with serum chloride concentration (p < 0.006). Conclusion The daily chloride load significantly influenced the acid‐base and biochemical status of intensive care unit patients. The higher the chloride load, patients are more likely to develop metabolic acidosis, hyperchloraemia and decreased sodium chloride difference.