In patients with septic shock, AKI is common and associated with adverse outcomes, but it is not influenced by protocolized resuscitation compared with usual care.

Elevated plasma concentrations of inflammatory and apoptosis biomarkers are associated with RRT dependence and death. Our data suggest that future interventions should investigate broad-spectrum immune-modulation to improve outcomes.

Objective We sought to investigate if the chloride content of fluids used in resuscitation was associated with short and long-term outcomes. Design We identified patients who received large volume fluid resuscitation (LVR), defined as greater than 60ml/kg over a 24 hour period. Chloride load was determined for each patient based on the chloride ion concentration of the fluids they received during LVR multiplied by the volume of fluids. We compared the development of hyperchloremic acidosis (HCA), AKI and survival among those with higher and lower chloride loads. Setting University Medical Center Patients Patients admitted to intensive care units (ICUs) from 2000–2008 Interventions None Main Results Among 4,710 patients receiving LVR HCA was documented in 523 (11%). Crude rates of HCA, AKI and hospital mortality all increased significantly as chloride load increased (p<0.001). However, chloride load was no longer associated with HCA or AKI after controlling for total fluids, age, and baseline severity. Conversely, each 100 mEq increase in chloride load was associated with a 5.5% increase in the hazard of death even after controlling for total fluid volume, age and severity (p=0.0015) over one year. Conclusions Chloride load is associated with significant adverse effects on survival out to one year even after controlling for total fluid load, age and baseline severity of illness. However the relationship between chloride load and development of HCA or AKI is less clear and further research is needed to elucidate the mechanisms underlying the adverse effects of chloride load on survival.