Serum chloride in heart failure: a salty prognosis

Vaduganathan, Muthiah; Pallais, J. Carl; Fenves, Andrew Z.; Butler, Javed; Gheorghiade, Mihai

doi:10.1002/ejhf.546

Cited by 14 publications

(20 citation statements)

References 25 publications

(29 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The chloride ion (Cl − , molar mass 35.45 g/mol) is the principal extracellular anion in humans [ 1 – 3 ]. Intra- and extracellular chloride concentrations range from 2 to 5 mmol/L (skeletal muscles) to about 90 mmol/L (erythrocytes), and 97–107 mmol/L (plasma).…”

Section: Reviewmentioning

confidence: 99%

“…High-volume bicarbonate infusion may result in Cl − being exchanged for bicarbonate in order to maintain electroneutrality [ 1 ]. Key to understanding of hypochloremia thus is assessment of potential iatrogenic effects and/or related use of diuretics [ 3 ]. Especially, the use of furosemide is clearly associated with the occurrence of metabolic alkalosis [ 22 ].…”

Section: Reviewmentioning

confidence: 99%

“…Hypochloremia seems of particular importance in heart failure patients where low levels of serum chloride indicate advanced disease, and are associated with decreased left ventricular ejection fraction [ 38 , 67 – 69 ], increased cardiac function markers (e.g., NT-pro-BNP) [ 38 , 68 ], and circulating catecholamine levels [ 70 ]. In fact, hypochloremia was identified as an independent predictor for adverse outcome in heart failure patients and was recently recognized to predict mortality in affected patients [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

“…Hypochloremia was also linked to mortality in several studies [ 38 , 67 , 68 , 70 , 75 , 78 ] and may be of special importance in patients with heart failure. An inverse relationship of Cl − levels with mortality in patients with compensated and non-compensated heart failure was shown [ 3 , 38 , 67 ]. Some studies showed an independent effect of hypochloremia (< 100 mmol/l) on cardiovascular, non-cardiovascular, and all-cause mortality [ 38 , 67 , 79 ].…”

Section: Reviewmentioning

confidence: 99%

“…All-cause mortality rates were increased even after 5 years of follow-up following initial hypochloremia [ 67 ]. Moreover, a recent editorial concludes that reduced serum Cl − levels may be of higher prognostic importance than increased sodium levels in heart failure patients [ 3 ].…”

Section: Reviewmentioning

confidence: 99%

See 4 more Smart Citations

Serum chloride levels in critical illness—the hidden story

Pfortmueller

Uehlinger

Haehling

et al. 2018

ICMx

View full text Add to dashboard Cite

Chloride is the principal anion of the extracellular fluid and vital for both serum electroneutrality and acid-base homeostasis. The aim of this review is to investigate the relevance of dyschloremia in the critically ill.An extensive literature research was conducted on www.pubmed.org. In addition, the references of included articles were searched for further possible investigation regarding chloride.Articles investigating the relevance of dyschloremia in the critically ill were included.All articles were screened in regard to dyschloremia in the critically ill.Chloride is essential for blood pressure control, decarboxylation/gas transport, renal function, and gastrointestinal homeostasis. “Dyschloremia,” i.e., serum chloride levels not within the limits of normal, may commonly be observed on ICUs and appear mainly induced by iatrogenic measures (i.e., infusion of chloride-rich fluids). Hypo- and hyperchloremia appear linked to increased mortality in defined ICU populations, but evidence is sparse. Data show that hyperchloremia may not only be linked to hyperchloremic metabolic acidosis, but also to increased hemodynamic instability and vasopressor need (e.g., in patients after major surgery). Nevertheless, it is currently unknown whether such effects would be directly or indirectly mediated. Moreover, recent evidence points to an increased incidence of acute kidney injury and need for renal replacement therapy in patients with advanced hyperchloremia.Current knowledge on chloride is largely limited by heterogeneous trial design and mostly abundant data on specific fluid replacement strategies. The aim of this review is to summarize key consequences of chloride in critical illness and to discuss implications for daily clinical practice and future research.

show abstract

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

Section: Reviewmentioning

confidence: 99%

See 3 more Smart Citations

Serum chloride levels in critical illness—the hidden story

Pfortmueller

Uehlinger

Haehling

et al. 2018

ICMx

View full text Add to dashboard Cite

show abstract

Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance

Cuthbert

Pellicori

Rigby

et al. 2018

European J of Heart Fail

View full text Add to dashboard Cite

show abstract

Electrolyte and Acid–Base Disturbances in Emergency High‐Risk Abdominal Surgery, a Retrospective Study

et al. 2022

View full text Add to dashboard Cite

BACKGROUNDPatients undergoing emergency high-risk abdominal surgery potentially suffer from both systemic dehydration and hypovolaemia. Data on the prevalence and clinical impact of electrolyte disturbances in this patient group, speci cally the potential differences in patients with intestinal obstruction (IO) versus perforated viscus (PV) is lacking. METHODSIn this retrospective single center cohort study, adult patients undergoing emergency high-risk abdominal surgery in a standardized perioperative pathway were included. Electrolyte and arterial blood gas analysis were measured prior to and just after surgery. Prevalence and clinical impact of electrolyte disturbances were assessed. RESULTSA total of 354 patients were included in the study. Acid-base and electrolyte disturbances had a high incidence in both groups with preoperative alkalemia dominating preoperatively, signi cantly more prevalent in IO (45 vs.32%, p<.001), and acidosis being most pronounced postoperatively in PV (49 vs. 28%, p<.0001). Preoperative hypochloraemia and hypokalemia were more prevalent in the IO group (34 vs 20 % and 37 vs 25 % respectively).Hyponatremia was highly prevalent in both IO and PV.Of the electrolyte and acid-base disturbances pre-and postoperative hypochloremia were the only ones independently associated with day-30 postoperative major complications and/or death in patients with IO, OR 2.87 (1.35, 6.23) p= 0.006 and OR 6.86 (1.71, 32.2) p= 0.009 respectively. Hypochloremic patients presented with reduced long-term survival as compared with the normo-and hyperchloremic patients, with postoperative hypochloremia having the most pronounced association (p<0.05).Neither plasma sodium nor potassium showed association with outcome. CONCLUSIONThese observations suggest that both acute high risk abdominal patient have frequent preoperative alkalosis shifting to postoperative acidosis, and that both pre-and postoperative hypochloremia are independently associated with both impaired short-and long-term outcome in patients with intestinal obstruction, which potential implications for the choice of resuscitations uids. Research on pathophysiology and treatment strategies for electrolyte disturbances are needed in patients undergoing emergency high-risk abdominal surgery. BackgroundIntravenous uid therapy is one of the most frequent interventions in critically ill patients(1). All high-risk surgical patients are given intravenous uid therapy(2) and abnormalities in acid-based homeostasis and electrolytes are common but insu ciently described.Patients undergoing emergency high-risk abdominal surgery due to e.g. intestinal obstruction (IO) or perforated viscus (PV) potentially suffer from systemic dehydration due to inadequate uid intake, vomiting ,pathological

show abstract

Serum chloride in heart failure: a salty prognosis

Cited by 14 publications

References 25 publications

Serum chloride levels in critical illness—the hidden story

Serum chloride levels in critical illness—the hidden story

Low serum chloride in patients with chronic heart failure: clinical associations and prognostic significance

Electrolyte and Acid–Base Disturbances in Emergency High‐Risk Abdominal Surgery, a Retrospective Study

Contact Info

Product

Resources

About