Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation.
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.
Skellett
S
S
Paediatric Intensive Care Unit, Guy's and St Thomas' Hospital, London SE1 9RT, UK.
Mayer
A
A
Durward
A
A
Tibby
S M
SM
Murdoch
I A
IA
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*
D002712:Chlorides; D012965:Sodium Chloride