Kyle Champagne, PharmD
PGY-1 Pharmacy Resident
Boston Medical Center
Weymouth, Massachusetts, United States
Disclosure information not submitted.
Philip Grgurich, BCCCP,
Professor of Pharmacy Practice
Massachusetts College of Pharmacy, Massachusetts
Disclosure information not submitted.
Katharine Nault, PharmD, MBA, BCCCP
Surgical ICU Clinical Pharmacy Specialist
Lahey Hospital & Medical Center, United States
Disclosure information not submitted.
Title: Identifying drivers of hyperchloremia in critically ill adults
Introduction: Recent studies have described a relationship between hyperchloremia and all-cause mortality and acute kidney injury (AKI). Hyperchloremia is most often iatrogenic. The primary aims of this study were to describe the progression of hyperchloremia and identify sources contributing to hyperchloremia in intensive care unit (ICU) patients.
Methods: This was a single-center retrospective study of adults admitted to medical, surgical, and cardiac ICUs for 1-7 days between 6/1/19-8/31/19. Patients were excluded if they were transferred from an outside hospital, had subarachnoid hemorrhage, traumatic brain injury, or diabetic ketoacidosis, underwent cardiac surgery, or died before ICU discharge. Data regarding demographics, comorbidities, daily serum chloride, and chloride administered from fluids were collected. Patients with maximum serum chloride of >110 mEq/L were assigned to the hyperchloremia group while similar patients with lower maximum serum chloride were assigned to the control group in equal numbers. Nonparametric data were compared using chi-square test and parametric data were compared using Student's t-test.
Results: Of 607 patients screened, 89 (15%) had hyperchloremia. Median serum chloride was 113 mEq/L and 106 mEq/L for hyperchloremic and control patients, respectively. Septic shock (27% vs 15%, P=0.11) and AKI (32% vs 23%, P=0.30) occurred at similar rates in both groups, however heart failure was less common in the hyperchloremia group (17% vs 33%, P< 0.05). Hyperchloremic patients were more frequently treated in the surgical ICU (36% vs 16%, P< 0.05), and less often treated in the medical ICU (49% vs 58%, P</em>=0.02). 60% of hyperchloremic patients remained hyperchloremic until ICU discharge or ICU day 7. Patients with hyperchloremia received more chloride from all sources as compared to those without hyperchloremia (714 vs 189 mEq, P< 0.05). Maintenance (289; IQR, 0-598 mEq), then bolus (154; IQR, 0-304 mEq), then medication carrier fluids (124; IQR, 49-261 mEq) contributed the most chloride among hyperchloremic patients.
Conclusion: Most patients with hyperchloremia remained hyperchloremic throughout their ICU admission. Hyperchloremic patients received more chloride from maintenance, bolus, and medication carrier fluids when compared to those who did not experience hyperchloremia.