Is hyperchloremia associated with mortality in critically ill patients? A prospective cohort study

Evidence-based fluid management in the ICU

“…Saline is still the mostly used crystalloid all over the world although it causes hyperchloremic acidosis which is known to impair renal function and promote infections [55][56][57][58][59]. Beside the association of hyperchloremic acidosis with these harmful conditions, recent indirect evidence suggests that saline might even increase mortality.…”

The Liver in Critical Illness

“…Serum chloride levels should drive selection of resuscitative fluid because, if patients are hyperchloremic, chloride-rich formulations (0.9% NaCl and 5% albumin) should be avoided due to the association of hyperchloremic metabolic acidosis with renal dysfunction and mortality. 32,33 If arterial hypotension persists despite adequate volume expansion, norepinephrine is the vasopressor of choice to achieve sustained MAP greater than or equal to 65 mm Hg. All vasopressors must be initiated with the knowledge that the effect on CBF and ICP directly follows changes in arterial pressure because of loss of cerebral autoregulation.…”

Effects of a new intravenous electrolyte solution for veterinary therapy on the electrolyte and acid-base balances of healthy horses

“…Evidence in humans has accumulated in support to the concept that hyperchloremia should be avoided because it is related to other indicators of poor prognoses and is associated with a high mortality rate (BONIATTI et al, 2011). Sick individuals tend to retain chloride (Cl -) in the body due to reduction in the renal excretion of this ion (MASEVICIUS et al, 2013), and the infusion of electrolyte solutions containing elevated Cl -concentrations may be unsuitable and contribute to the worsening of this imbalance (YOUNG et al, 2014).…”