Hyperchloraemia causes metabolic acidosis by reducing strong ion difference

Dorje, Pema; Bree, Stephen; Adhikary, Gaury S.; Mclaren, D. I.

doi:10.1046/j.1365-2044.2000.01250.x

Cited by 3 publications

(4 citation statements)

References 3 publications

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“…Ringer's lactate cannot be used in the same intravenous catheter with citrated packed red cells because of the calcium present in Ringer's lactate. Although 0.9% (normal) saline must be used through those catheters, it should not be rapidly administered in large quantities because of the profound reduction in the SID that excessive chloride produces, leading to hyperchloremic acidosis [8,10,40]. The lactate within Ringer's lactate does not significantly contribute to hyperlactemia or acidemia(osis) except in extremely rare circumstances when no lactate can be metabolized [41].…”

Section: Resultsmentioning

confidence: 99%

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Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

Powner¹,

Kellum²,

Darby³

2001

J Intensive Care Med

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Powner DJ, Kellum JA, Darby JM. Concepts of the strong ion difference applied to large volume resuscitation. J Intensive Care Med 2001;16:169–176. The occurrence of acidosis following trauma or other clinical conditions that require large volumes of resuscitation fluid may be modified by manipulation of the physical chemistry properties of substances within plasma. These include the strong ion difference, modification of hydrogen ion production through control of alveolar ventilation, and protection/provision of protein and phosphate‐based weak acids. An understanding of these principles as an alternative method to analyze/anticipate acid‐base abnormalities is important during resuscitation. Loss of protein‐based weak acids may often occur after trauma or other conditions requiring large‐volume resuscitation. These losses may potentially be replaced with albumin‐based colloid solutions. Large quantities of normal saline should be avoided so as to avoid hyperchloremia‐induced metabolic acidosis. Ringer's lactate solution is preferred. Alveolar ventilation must be adjusted so as to eliminate further hydrogen ion production caused by hypercarbia. The serum base excess and/or hyperlactemia have only limited value in diagnosing acidosis and guiding resuscitation. Current experimental data and reviews of this topic were obtained from a Medline literature search. In addition, the personal experience and investigations of the authors in critically ill and injured patients were used to formulate recommendations.

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Section: Resultsmentioning

confidence: 99%

“…The secondary compensation through Cl excretion by the kidneys does not occur quickly enough to protect against acute acidemia. Such patients may present with metabolic acidosis related to hyperchloremia and reduced SID [8‐10]. Therefore rapid infusion of large quantities of normal saline should be avoided during resuscitation.…”

Section: Clinical Correlationmentioning

confidence: 99%

Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

Powner¹,

Kellum²,

Darby³

2001

J Intensive Care Med

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“…A quantitative approach was applied to our data making it possible to separate and quantify these 2 components: UA 10 and reduced SID. 11 Because sodium levels are controlled mainly by osmoreceptors and baroreceptors and the other components of SID are quantitatively small, one can assume that variations in the SID that affect acid-base status are due to changes in chloride levels. 11 It is well established that alkali administration is recommended in CKD patients to maintain serum bicarbonate levels .22 mEq/L.…”

Section: Discussionmentioning

confidence: 99%

“…11 Because sodium levels are controlled mainly by osmoreceptors and baroreceptors and the other components of SID are quantitatively small, one can assume that variations in the SID that affect acid-base status are due to changes in chloride levels. 11 It is well established that alkali administration is recommended in CKD patients to maintain serum bicarbonate levels .22 mEq/L. 12 Metabolic acidosis correction has demonstrated beneficial effects on secondary hyperparathyroidism control, reducing muscle wasting and CKD progression.…”

Section: Discussionmentioning

confidence: 99%

Metabolic Acidosis Components in Advanced Chronic Kidney Disease: Association With Serum Albumin and Parathyroid Hormone

Vasconcelos

Queiroz

Costa

et al. 2015

Journal of Renal Nutrition

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Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

Powner

Kellum

Darby

2001

J Intensive Care Med

View full text Add to dashboard Cite

Concepts of the strong ionThe alternate method of evaluating acid-base status difference applied to large volume resuscitation. J Intensive Care as a function of the strong ion difference, PaCO 2 , Med 2001;16:169-176. and other weak acids is important for patients re-The occurrence of acidosis following trauma or other clinical quiring rapid intravenous administration of large conditions that require large volumes of resuscitation fluid volumes of fluids. This system was developed and may be modified by manipulation of the physical chemistry published by Stewart [1] more than a decade ago properties of substances within plasma. These include the and has gained increasing popularity in multidiscistrong ion difference, modification of hydrogen ion production through control of alveolar ventilation, and protection/ plinary critical care. Reviews of this method of analprovision of protein and phosphate-based weak acids. An ysis and related controversies have been presented understanding of these principles as an alternative method at many levels of biochemical complexity in a varito analyze/anticipate acid-base abnormalities is important ety of clinical disorders [2-6]. during resuscitation. Loss of protein-based weak acids may It is our intent to relate this system of analysis to the often occur after trauma or other conditions requiring largevolume resuscitation. These losses may potentially be retrauma patient during initial resuscitation or other placed with albumin-based colloid solutions. Large quantities patients requiring similar emergent fluid therapy. An of normal saline should be avoided so as to avoid hyperchlorunderstanding of Stewart's approach allows the emia-induced metabolic acidosis. Ringer's lactate solution is physician to anticipate acid-base changes and perpreferred. Alveolar ventilation must be adjusted so as to haps ameliorate them through proper selection of eliminate further hydrogen ion production caused by hypercarbia. The serum base excess and/or hyperlactemia have resuscitation fluids and adjustments in mechanical only limited value in diagnosing acidosis and guiding resusciventilation. Recognizing the severe consequences tation. Current experimental data and reviews of this topic of any altered acid-base balance [7], we will primarwere obtained from a Medline literature search. In addition, ily emphasize acidosis(emia) as this is the more the personal experience and investigations of the authors common abnormality during such clinical situain critically ill and injured patients were used to formulate recommendations.

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Hyperchloraemia causes metabolic acidosis by reducing strong ion difference

Cited by 3 publications

References 3 publications

Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

Metabolic Acidosis Components in Advanced Chronic Kidney Disease: Association With Serum Albumin and Parathyroid Hormone

Concepts of the Strong Ion Difference Applied to Large Volume Resuscitation

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