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

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.

Biomolecular Interactions and Anticancer Mechanisms of Ru(II)-Arene Complexes of Cinnamaldehyde-Derived Thiosemicarbazone Ligands: Analysis Combining In Silico and In Vitro Approaches

“…Nevertheless, when the concentration of chloride ions was raised to 110 mM (as shown in Figure (b)), the process of hydrolysis was effectively inhibited. These findings suggest that when chloride ion levels are high, such as in the bloodstream, the complexes may continue to exist unless they undergo alternate metabolic routes, such as binding with proteins. , Hydrolysis is widely postulated to occur intracellularly, where the chloride ion concentration generally decreases to approximately 4 mM.…”

Diretrizes Clínicas da ABRAMEDE para o Manejo de Dengue em Pacientes Adultos na Emergência

“…O uso excessivo de solução salina está associado a um risco aumentado de desenvolver acidose hiperclorêmica. 61 Dito isso, ambas as opções são razoáveis, porém o painel da ABRAMEDE sugere que o ringer lactato seja o cristaloide de primeira escolha.…”

The Integral Role of Chloride & With-No-Lysine Kinases in Cell Volume Regulation & Hypertension

“…In humans, chloride anions represent approximately 70% of all anions, and the body of an average adult contains approximately 115 gr of chloride. 17 The extracellular chloride concentration is relatively constant and is maintained between 95 and 120 mM among various species as a function of the kidney and intestine, which regulate its absorption and secretion. In humans, extracellular chloride concentration is maintained between 97 and 107 mM.…”

“…In humans, extracellular chloride concentration is maintained between 97 and 107 mM. 17,21 The intracellular chloride concentration is maintained via complex and sophisticated manipulations. Even in the absence of active transport by the cell membrane, the intracellular chloride concentration is lower than that in the extracellular space due to Gibbs-Donnan disequilibrium.…”