Jessica Christiano, MD
Pediatric Critical Care Fellow
Ann and Robert H Lurie Childrens Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
L. Nelson Sanchez-Pinto, MD, MBI
Assistant Professor of Pediatrics (Critical Care)
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois
Disclosure information not submitted.
Matthew Barhight, MD
Attending Physician, Division of Critical Care
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, Illinois, United States
Disclosure information not submitted.
Title: Evaluation of Chloride Load, Serum Chloride, and Clinical Outcomes in Critically Ill Children
Introduction: Hyperchloremia is associated with increased morbidity and mortality in critically ill children, but it is unknown if the intravenous (IV) chloride amount administered (chloride load) is associated with hyperchloremia or poor outcomes. The aim of this study is to describe the association of chloride load, serum chloride, and clinical outcomes. We hypothesize that IV chloride load is associated with increased frequency hyperchloremia and acute kidney injury (AKI).
Methods: Retrospective cohort study of patients age 0-18 years admitted from the emergency department to pediatric intensive care unit at a quaternary care hospital. Patients who did not receive chloride-containing IV fluids, did not have laboratory data days 1-3, or had chronic kidney disease were excluded. The IV chloride load (mEq/kg) inclusive of fluid boluses, maintenance fluids, medications, and blood products through the first day of admission was calculated. Primary outcome was day 3 severe AKI. Secondary outcomes were day 2 severe AKI, ventilator-free days in 28 (VFD), hospital length of stay (LOS), in-hospital mortality, frequency of hyperchloremia, change in serum chloride from admission, and day 2 serum chloride. Adjusted analyses accounted for a-priori-defined confounders of age, PRISM III score, immunocompromised state, septic shock, invasive ventilation in the first 3 days.
Results: There were 1,119 hospital admissions included, with a median age of 5.5 years (1.7-12.9), median PRISM III score of 7 (3-12), and median chloride load was 10.8mEq/kg (7.2-15.4). After adjusting for confounders, chloride load (mEq/kg) was associated with decreased odds of day 2 and 3 severe AKI (OR 0.84, 95% CI: 0.77-0.92 and OR 0.89, 95% CI: 0.83-0.96), increased odds of hyperchloremia (OR 1.04, 95% CI: 1.02-1.07), and higher day 2 serum chloride (coefficient 0.15, 95% CI: 0.08-0.22). Chloride load’s association with VFD, hospital LOS, in-hospital mortality, and change in serum chloride from baseline was not significant after adjusting for confounders.
Conclusions: IV chloride load is independently associated with decreased odds of day 2 and 3 severe AKI, increased odds of hyperchloremia, and higher day 2 serum chloride in critically ill children. Prospective studies are warranted to explore the relationship between IV chloride load and outcomes.