Implications of hyperchloremia in critically ill patients

Abstract

Hyperchloremia is a repeated insult in critically ill subjects, leading to more morbidity and mortality. There is a strong relation between hyperchloremia with mortality and morbidity, as renal injury, more extended ICU stay, more mechanical ventilation (MV) period, and other electrolyte disturbances. Our aim is to evaluate the association of hyperchloremia in critically ill subjects with the incidence of mortality and also to study the development of morbidities such as renal injury and electrolyte disturbances and development of metabolic acidosis and its relationship to the period of MV and ICU stay time. A total number of 400 patients subjected to hyperchloremia estimation and laboratory tests were divided into two groups: hyperchloremic group (HG) and non-hyperchloremic group (NHG). The whole incidence of hyperchloremia for the total cohort has been estimated, as well as the whole incidence of mortality, duration of MV, ICU stay time, development of renal injury, and its association with occurrence of metabolic acidosis and electrolyte disturbances among the HG and NHG. The study included 400 patients, 180 of them (45%) were HG, and 220 (55%) were NHG. Mortality was more in 128 HG patients (71.1%), while 48 patients died (21.8%) in NHG (p-value = 0.005). The incidence of morbidities was more in HG than NHG as more; period of MV, ICU stay, renal injury, acidosis and more electrolyte disturbances (p-value < 0.05). Hyperchloremic patients had an increased incidence of mortality. Moreover, they were susceptible to longer mechanical ventilation, ICU stay, renal injury, metabolic acidosis, and electrolytes disorders.

Keywords

• Hyperchloremia
• renal injury
• mechanical ventilation
• acidosis