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Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation
S Skellett1, A Mayer, A Durward
1Paediatric Intensive Care Unit, Guy's and St Thomas' Hospital, London SE1 9RT, UK.
Insights
0.9% saline resuscitation in children with septic shock can cause persistent base deficit due to hyperchloremic metabolic acidosis. This highlights the need for caution when using chloride-rich fluids in pediatric critical care.
Area of Science:
- Pediatric Critical Care Medicine
- Acid-Base Physiology
- Resuscitation Science
Background:
- Base deficit is a key indicator of illness severity in acidotic children.
- Septic shock management often involves large-volume fluid resuscitation.
- The impact of fluid composition on acid-base balance requires further investigation.
Purpose of the Study:
- To investigate the cause of persistent base deficit in children with septic shock.
- To evaluate the role of 0.9% saline in iatrogenic hyperchloremic metabolic acidosis.
- To apply Stewart's strong ion theory to understand acid-base disturbances in this context.
Main Methods:
- Case series presentation of five children with septic shock.
- Application of Stewart's strong ion theory to analyze acid-base parameters.
- Quantification of metabolic acidosis causes, focusing on chloride load.
Main Results:
- Patients presented with persistent base deficit despite large-volume 0.9% saline resuscitation.
- Analysis revealed hyperchloremic metabolic acidosis as the cause of persistent base deficit.
- The high chloride content of 0.9% saline was identified as the contributing factor.
Conclusions:
- 0.9% saline may not be an ideal resuscitation fluid in pediatric septic shock.
- Chloride-rich fluids can induce or exacerbate hyperchloremic metabolic acidosis.
- Clinicians should be aware of the potential for persistent base deficit when using such fluids.
Abstract:
Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how "sick" they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid-base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit.