Editorial Views  |   October 2016
Chloride Conundrums
Author Notes
  • From the University of South Alabama College of Medicine, Mobile, Alabama.
  • Corresponding article on page 744.
    Corresponding article on page 744.×
  • Accepted for publication July 6, 2016.
    Accepted for publication July 6, 2016.×
  • Address correspondence to Dr. Teplick: rteplick@southalabama.edu
Article Information
Editorial Views / Cardiovascular Anesthesia / Critical Care / Renal and Urinary Systems / Electrolyte Balance
Editorial Views   |   October 2016
Chloride Conundrums
Anesthesiology 10 2016, Vol.125, 622-624. doi:10.1097/ALN.0000000000001274
Anesthesiology 10 2016, Vol.125, 622-624. doi:10.1097/ALN.0000000000001274
FOR years, there has been controversy over both the type and the amount of fluid patients should receive, especially for resuscitation in sepsis or septic shock. Recently, the debate has shifted from crystalloids versus colloids to whether “balanced” salt solutions (BSSs) are superior to 0.9% sodium chloride (“normal saline” [NS]) because of data linking adverse effects to the high chloride in NS. Lactated Ringer’s solution (LR) and PlasmaLyte are commonly used BSSs, so named because their composition more closely resembles plasma, although lactate or acetate is added to permit near-normal concentrations of chloride. Two major concerns with the high-chloride concentration in NS are as follows: (1) large volume infusions or even just several liters infused rapidly in healthy individuals result in a nonanion gap metabolic acidemia because the high chloride in NS decreases the strong ion difference, although dilution of bicarbonate is an alternate, albeit less physiologic explanation1,2 ; and (2) hyperchloremia can produce vascular constriction, increase vascular reactivity to vasoconstrictors, and reduce renal perfusion, possibly causing acute kidney injury (AKI). Are the animal and human data sufficient to suggest curtailing the use of NS for resuscitation?
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