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Hyperchloremic Acidosis

Parekh, Nilesh

doi: 10.1097/00000539-200212000-00075
LETTERS TO THE EDITOR: Letters & Announcements
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Department of Critical Care & Anaesthesia

New Cross Hospital

Wolverhampton, United Kingdom

To the Editor:

The recent editorial (1) and original article (2) on hyperchloremic acidosis made interesting reading.

In the past, hyperchloremic acidosis contributed to misdiagnosis in one of our patients, leading to unnecessary laparotomy and initiation of dopexamine infusion. In view of this occurrence and recent publications on the subject (1,2), an audit of this biochemical abnormality was initiated. The audit period was 6 weeks. We collected the data on demographics, APACHE II, type and amount of intravenous fluid received before admission to critical care unit, analysis of arterial blood gases, electrolytes, serum lactate, total intake, and urine output in the first 24 hours. A total of 24 patients were studied. Sixteen patients had BE > −2.0 (range, −2.1 to −10.2 mEg/L). Serum chloride was increased in 23 patients (range, 109–133 mmols/dL), and serum lactate was normal (ref value <1.78 mEg/L) in 12 patients, seven of which had BE > −2.0 (range, −2.1 to −8.8 mEg/l) and pH <7.35.

In this small study, we saw hyperchloremic acidosis in 29% (7 of 24) cases. Normal saline (0.9%) was the predominant intravenous fluid given to these patients. The audit has increased awareness of this entity among trainee doctors and nurses in our unit. Whether this will change the anesthetic practice or not remains to be seen. I have changed mine.

Nilesh Parekh

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References

1. O’Connor MF, Roizen MF. Lactate versus chloride: which is better? Anesth Analg 2001; 93: 809–10.
2. Wilkes NJ, Woolf R, Mutch M, et al. The effects of balanced versus saline based intravenous solutions on acid base and electrolyte status and gastric mucosal perfusion in elderly surgical patients. Anesth Analg 2001; 93: 811–6.
© 2002 International Anesthesia Research Society