title: Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation.
abstract: Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how "sick" they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid-base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit.
authors.affiliation: Paediatric Intensive Care Unit, Guy's and St Thomas' Hospital, London SE1 9RT, UK.
authors.forename: S
authors.initials: S
authors.lastname: Skellett
authors.forename: A
authors.initials: A
authors.lastname: Mayer
authors.forename: A
authors.initials: A
authors.lastname: Durward
authors.forename: S M
authors.initials: SM
authors.lastname: Tibby
authors.forename: I A
authors.initials: IA
authors.lastname: Murdoch
mesh_terms: D000138:Acidosis / Q000097:blood / Q000209:etiology*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D002712:Chlorides / Q000097:blood; D005440:Fluid Therapy / Q000009:adverse effects*; D006801:Humans; D012772:Shock, Septic / Q000628:therapy; D012965:Sodium Chloride / Q000009:adverse effects*
chemical_list: D002712:Chlorides; D012965:Sodium Chloride