Hyperchloremia in Intensive Care Unit Mortality: An Underestimated Fact.

Area of Science:

• Critical Care Medicine
• Clinical Chemistry
• Nephrology

Background:

• Hyperchloremia is an electrolyte imbalance associated with increased mortality.
• Chloride-rich intravenous fluids are commonly used in intensive care units (ICUs).
• The impact of chloride-rich fluids on hyperchloremia in critically ill patients warrants investigation.

Purpose of the Study:

• To determine the prevalence of hyperchloremia in patients who died in a medical ICU.
• To highlight the potential risks of chloride-rich intravenous fluids.
• To emphasize the need for careful fluid management in critical care.

Main Methods:

• A retrospective study of 206 patients who expired in a medical ICU over one year.
• Serum chloride levels were measured at admission and 72 hours.
• Hyperchloremia was defined as serum chloride levels ≥ 107 meq/dl.

Main Results:

• 50.5% of patients developed hyperchloremia by 72 hours in the ICU.
• Hyperchloremia was more prevalent in patients with sepsis or septic shock.
• A significant percentage of deceased ICU patients exhibited hyperchloremia.

Conclusions:

• The high incidence of hyperchloremia suggests overuse of chloride-rich IV fluids.
• Hyperchloremia may contribute to mortality in critically ill patients.
• Consideration of chloride-poor fluids like lactated Ringer's may be beneficial for fluid resuscitation.