Hyperchloremia in critically Ill patients in ICU: Review Article

Abstract

Background: Chloride (Cl) is required for the regulation of blood pressure, renal function, gastrointestinal homeostasis and decarboxylation/gas transport. "Dyschloremia" or levels of serum Cl beyond the normal range, is a frequent occurrence in intensive care units and seems to be mostly caused by iatrogenic procedures (i.e. intravenous infusion of fluids rich in Cl). Hypochloremia and hyperchloremia seem to be related to high risk of death in specified intensive care unit (ICU) groups, although the data is inconclusive. Hyperchloremia may be associated with higher hemodynamic unstable changes and need for vasopressors, in addition to hyperchloremic metabolic acidosis (e.g., following major surgeries). Nonetheless, the direct or indirect mediation of these effects is still uncertain. Additionally, new research suggests that individuals with advanced hyperchloremia have a higher risk of acute renal damage and require renal replacement treatment. Objective: The purpose of this study was to describe significant chloride-related outcomes in critical illness and to evaluate their relevance for everyday clinical practice and therapeutic alternatives. Conclusion: One may conclude that the concern about understanding the impact of chloride disorders on negative outcomes is rising; there seems to be a link between chloride disorders and negative outcomes, particularly death, in the ICU setting; one could theorize the need to rationalize the use of solutions with electrolyte components separate from the physiological solutions; and consider the presence or the development of hyperchloremia as a prognostic factor, without taking into consideration the severity of the critical patient