Tuesday October 31, 2006
Bench to Bedside !!

Hyperchloremic acidosis is common in ICU patients secondary to IVF boluses with 0.9 NS and usually get ignored unless it becomes critical as we all take it as a benign phenomenon. But is it?

Dr. John A. Kellum and coll. from the MANTRA Laboratory, Department of Critical Care Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA looked into the magnitude of hyperchloremic acidosis with target choosen in investigation near clinical scenarios. They induced lethal sepsis in 20 adult rats and were randomized into three groups.

• In group 1 lactated Ringer solution was given.
• In group 2 an IV infusion of 0.1 N HCl given to reduce the standard base excess (SBE) by 5 to 10 mEq/L.
• In group 3 an IV infusion of 0.1 N HCl given to reduce the standard base excess (SBE) by 10 to 15 mEq/L.

In all groups infusion continued for 8 h or until the animal died. ABGs, lactate, chloride, TNF, interleukin (IL)-6, and IL-10 levels were measured at 0, 4 and 8 h. Compared to group 1, animals in groups 2 and 3 exhibited greater increase in all three cytokines, with the greatest increases seen with severe acidosis. Study concluded that hyperchloremic acidosis, induced by dilute Hcl infusion, significantly increased cytokine expression in a dose-dependent fashion.


Clinical significance / Editors' note: In camparison to surgical ICUs, medical ICUs are more inclined to use 0.9 NS which carries significantly higher content of chloride. In many instances, either LR or Normosol may be a better choice with low chloride content but still isotonic in nature. See related previous pearls below.

Difference between Lactate Ringer's and Normal Saline solutions

Normosol is NOT just Normal Saline



Reference: click to get abstract

Hyperchloremic Acidosis Increases Circulating Inflammatory Molecules in Experimental Sepsis - Chest. 2006;130:962-967