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Review
. 2020 Dec 10;9(1):40.
doi: 10.1186/s13741-020-00171-3.

Clinical physiology aspects of chloremia in fluid therapy: a systematic review

David Astapenko  1   2 , Pavel Navratil  3   4 , Jiri Pouska  5   6 , Vladimir Cerny  7   3   8   9   10   11
Affiliations
Review

Clinical physiology aspects of chloremia in fluid therapy: a systematic review

David Astapenko et al. Perioper Med (Lond). .

Abstract

Background: This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates.

Methods: Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word "chloride," infusion therapy, metabolic acidosis, renal failure, and review.

Results: A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed.

Conclusions: According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function.

Keywords: Chloride; Fluid therapy; Hyperchloremia; Metabolic acidosis; Renal failure.

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Conflict of interest statement

Authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA flow chart
Fig. 2
Fig. 2
CO2 carbon dioxide, H2CO3 carbonic acid, HCO3− bicarbonate anion, H+ hydrogen cation, Hb− hemoglobin, HHb hydrogen cation bound to hemoglobin, Cl− chloride anion
Fig. 3
Fig. 3
1—vas afferens, 2—vas efferens, 3—a glomerulus with Bowman’s capsule and primary urine, 4—distal tubule adhering to the glomerulus, 5—macula densa cells, 6—mesangial cells
See this image and copyright information in PMC

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