Hyperchloraemia: ready for the big time?

Abstract

Chloride is in many ways the forgotten electrolyte. Recent evidence suggests that hyperchloraemia results in metabolic acidosis, and is associated with renal dysfunction, increased mortality, coagulation disturbances, splanchnic ischaemia, and a proinflammatory state. The renal effects and the increased mortality are the best established and most concerning of these associations. The choice of intravenous fluids significantly influences the development of hyperchloraemia. Further studies are required to confirm or refute these associations. In the interim high-chloride fluids, most commonly 0.9% saline, should be avoided as resuscitation fluids.