UMEM Educational Pearls

Title: High Chloride Load Associated with Increased Mortality

Keywords: Fluids, Fluid resuscitation, Metabolic Acidosis (PubMed Search)

Posted: 9/27/2016 by Daniel Haase, MD
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TAKE HOME POINTS:

-- High chloride load is associated with adverse outcomes in large-volume resuscitation (>60mL/kg in 24h), including increased risk of death [1]

-- Avoid supraphysiologic chloride solutions (i.e. normal saline) when resuscitation volumes are likely to exceed 60mL/kg (e.g. sepsis, DKA)

-- Hyperchloremic metabolic acidosis (HMA) is frequently associated with large-volume resuscitation, particularly with normal saline (0.9% NS) [2]

--HMA can result in decreased renal blood flow and renal cortical hypoperfusion, even in healthy volunteers [3]

-- Chloride load is also associated with acute kidney injury in this study, but this effect goes away once severity of illness is controlled.

-- It is not clear why increased chloride load is associated with increased mortality

-- Consider more "physiologic" fluids, such as plasmalyte A

2. Kellum JA. Saline-induced hyperchloremic metabolic acidosis. Crit Care Med. 2002 Jan;30(1):259-61.