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Editorial
. 2019 Dec;7(Suppl 8):S264.
doi: 10.21037/atm.2019.12.48.

Is dyschloremia a marker of critical illness or euchloremia an interventional target to improve outcomes?

Fabrizio Canepa-Escaro  1 , Javier A Neyra  2
Affiliations
Editorial

Is dyschloremia a marker of critical illness or euchloremia an interventional target to improve outcomes?

Fabrizio Canepa-Escaro et al. Ann Transl Med. 2019 Dec.
No abstract available

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Conflict of interest statement

Conflicts of Interest: The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Theoretical approach of chloride-guided fluid resuscitation to achieve or maintain euchloremia. The critical first step is to determine if the patient requires and/or responds to intravenous fluids. Importantly, fluid therapy should be stopped when the patient is no longer fluid responsive. If the patient requires intravenous fluid therapy, proceed with a chloride-guided fluid resuscitation approach aiming for euchloremia: (I) if the patient is hypochloremic, administer isotonic 0.9% saline. When normochloremia is achieved and if intravenous fluids are still needed, transition to balanced solutions unless there are relative contraindications to consider (e.g., hypercalcemia, incompatibility with medications, etc.); (II) if the patient is euchloremic, favor balanced solutions to maintain euchloremia; (III) if the patient is hyperchloremic, favor balanced solutions or consider isotonic bicarbonate (the later only if pH is <7.20 and/or serum bicarbonate <12 mmol/L and if strict monitoring of electrolytes is available), otherwise continue balanced solutions to prevent worsening hyperchloremia.
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