title: Chloride toxicity in critically ill patients: What's the evidence?
abstract: Crystalloids have become the fluid of choice in critically ill patients and in the operating room both for fluid resuscitation and fluid maintenance. Among crystalloids, NaCl 0.9% has been the most widely used fluid. However, emerging evidence suggests that administration of 0.9% saline could be harmful mainly through high chloride content and that the use of fluid with low chloride content may be preferable in major surgery and intensive care patients. Administration of NaCl 0.9% is the leading cause of metabolic hyperchloraemic acidosis in critically ill patients and side effects might target coagulation, renal function, and ultimately increase mortality. More balanced solutions therefore may be used especially when large amount of fluids are administered in high-risk patients. In this review, we discuss physiological background favouring the use of balanced solutions as well as the most recent clinical data regarding the use of crystalloid solutions in critically ill patients and patients undergoing major surgery.
authors.affiliation: Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France. Electronic address: sabri.soussi@sls.aphp.fr.
authors.forename: Sabri
authors.initials: S
authors.lastname: Soussi
authors.affiliation: Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France. Electronic address: axelle.ferry@sls.aphp.fr.
authors.forename: Axelle
authors.initials: A
authors.lastname: Ferry
authors.affiliation: Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France. Electronic address: maite.chaussard@gmail.com.
authors.forename: Maité
authors.initials: M
authors.lastname: Chaussard
authors.affiliation: Department of Anaesthesiology and Critical Care, Smur, Burn Unit, AP-HP, groupe hospitalier Saint-Louis-Lariboisière, 75010 Paris, France; Institut national de la santé et de la recherche médicale (Inserm), UMR Inserm 942, Lariboisière hospital, 75010 Paris, France; Université Paris Diderot, 75475 Paris, France. Electronic address: matthieu.m.legrand@gmail.com.
authors.forename: Matthieu
authors.initials: M
authors.lastname: Legrand
mesh_terms: D000137:Acid-Base Imbalance / Q000097:blood / Q000139:chemically induced; D002712:Chlorides / Q000009:adverse effects* / Q000097:blood*; D016638:Critical Illness; D000077324:Crystalloid Solutions; D006801:Humans; D007552:Isotonic Solutions; D015532:Rehydration Solutions; D012965:Sodium Chloride / Q000009:adverse effects*
chemical_list: D002712:Chlorides; D000077324:Crystalloid Solutions; D007552:Isotonic Solutions; D015532:Rehydration Solutions; D012965:Sodium Chloride
keywords: Balanced crystalloid; Chloride; Hyperchloraemic acidosis; Intensive care; Strong ion difference