Shad Zahid Siddique, Qureshi Muhammad Shoaib Safdar, Qadeer Aayesha, Abdullah Azmat, Munawar Kamran, Khan Muhammad Tariq, Saeed Luqman, Hussain Syed Waqar
Internal Medicine, Shifa International Hospital, Islamabad, PAK.
Internal Medicine, Khan Research Laboratories Hospital, Islamabad, PAK.
Cureus. 2019 May 28;11(5):e4770. doi: 10.7759/cureus.4770.
Objective The goal of the study was to determine the percentage of hyperchloremia in patients who died in medical intensive care unit (ICU) and thus emphasizing the need of avoiding chloride-rich solutions due to their deleterious effects. Study design We conducted a retrospective study of data from 206 patients who expired in medical ICU in one year from January 2017 to December 2017 in the department of critical care medicine at Shifa International Hospital, Islamabad. Material and methods The study included 206 patients: 93 (43.1%) men and 123 (56.9%) women, over the age of 18 years who expired in medical ICU in one year from January 2017 to December 2017. Patients included for the study were all those who expired with any diagnosis but those who remained admitted in ICU for at least 72 hours and received intravenous fluids. The serum chloride levels of the patients at the time of admission and at 72 hours of stay in ICU were collected. The patients who were having serum chloride levels of 107 milliequivalent per deciliter (meq/dl) or more were labeled as having hyperchloremia. The data were analyzed using IBM SPSS Statistics for Windows, Version 23.0 (IBM Crop., Armonk, NY, USA). The mean and standard deviations were calculated for continuous variables while frequency and percentages were calculated for qualitative variables. Results Among 206 patients who expired in our ICU, 109 (50.5%) patients had hyperchloremia at 72 hours of admission in ICU while 107 (49.5%) patients did not had hyperchloremia. Hyperchloremia was more frequent in patients with sepsis or septic shock. Conclusion Higher percentage (50.5%) of hyperchloremia at 72 hours of admission among patients (who expired in our medical ICU) indicates excessive use of chloride-rich intravenous fluids. This finding may have significant impact on mortality along with other contributing factors that lead to death of the patients. Keeping in view the findings of the study, chloride-rich solutions should be used carefully to counter the effects of hyperchloremia in patients requiring large volume fluid resuscitation in ICU. Fluids with lower content of chloride such as lactated ringer may be equally good in large volume fluid resuscitation with advantage of avoiding hyperchloremia.
目的 本研究的目的是确定在医学重症监护病房（ICU）死亡患者中高氯血症的发生率，从而强调由于含氯溶液的有害影响而需避免使用它们。研究设计 我们对2017年1月至2017年12月在伊斯兰堡希法国际医院重症医学科一年内于医学ICU死亡的206例患者的数据进行了回顾性研究。材料和方法 该研究纳入了206例患者：93例（43.1%）男性和123例（56.9%）女性，年龄超过18岁，于2017年1月至2017年12月在医学ICU死亡。纳入研究的患者为所有有任何诊断而死亡但在ICU至少住院72小时并接受静脉输液的患者。收集患者入院时及在ICU住院72小时时的血清氯水平。血清氯水平每分升107毫当量（meq/dl）或更高的患者被标记为患有高氯血症。数据使用IBM SPSS Statistics for Windows，版本23.0（美国纽约州阿蒙克市IBM公司）进行分析。连续变量计算均值和标准差，定性变量计算频率和百分比。结果 在我们ICU死亡的206例患者中，109例（50.5%）患者在入住ICU 72小时时有高氯血症，而107例（49.5%）患者没有高氯血症。高氯血症在脓毒症或脓毒性休克患者中更常见。结论 （在我们医学ICU死亡的）患者入院72小时时高氯血症的发生率较高（50.5%），表明含氯静脉输液使用过度。这一发现可能对死亡率以及导致患者死亡的其他因素产生重大影响。鉴于该研究结果，在ICU需要大量液体复苏的患者中，应谨慎使用含氯溶液以应对高氯血症的影响。含氯量较低的液体如乳酸林格液在大量液体复苏中可能同样有效，且具有避免高氯血症的优势。
