2018
DOI: 10.3389/fneur.2018.00485
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Hyperchloremia Is Associated With Poorer Outcome in Critically Ill Stroke Patients

Abstract: Background and Purpose: This study aims to explore the cause and predictive value of hyperchloremia in critically ill stroke patients.Materials and Methods: We conducted a retrospective study of a prospectively collected database of adult patients with first-ever acute ischemic stroke (AIS) or intracerebral hemorrhage (ICH) admitted to the neurointensive care unit (NICU) of a university-affiliated hospital, between January 2013 and December 2016. Patients were excluded if admitted beyond 72 h from onset, if th… Show more

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Cited by 27 publications
(24 citation statements)
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“…Similar to recent evidence in patients with other underlying neurological pathologies, hyperchloremia may have an impact on overall clinical outcomes in this patient population. 11 -13…”
Section: Discussionmentioning
confidence: 99%
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“…Similar to recent evidence in patients with other underlying neurological pathologies, hyperchloremia may have an impact on overall clinical outcomes in this patient population. 11 -13…”
Section: Discussionmentioning
confidence: 99%
“…Interestingly, this study excluded patients receiving hypertonic saline (3% or 10%) or other types of crystalloids except 0.9% sodium chloride during the study period. 13 We chose to include all patients receiving treatments for cerebral edema that may contain high concentrations of sodium and chloride, as to better assess the impact of these therapies on outcomes. We also selected the threshold for hyperchloremia of chloride > 115 mmol/L to provide a more accurate assessment of the true relationship between elevated chloride levels and outcomes, as we felt the chloride threshold of 110 mmol/L may result in inclusion of patients who experienced only mild, transient elevations in chloride levels.…”
Section: Discussionmentioning
confidence: 99%
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“…Although there is no clear limit for diagnosing hyperchloremia, the most commonly accepted one is [Cl] >110 mEq/L. 42,[54][55][56] When hyperchloremia is associated with acidosis, then it is called hyperchloremic acidosis. Considering the Stewart paradigm, the difference between sodium and chloride should be narrowed, instead of increasing chloride concentration to determine whether hyperchloremia is the source of acidosis.…”
Section: Hyperchloremia and Hyperchloremic Acidosismentioning
confidence: 99%
“…Criticism on the subject has long been made by Schwartz and Relman [48], which even took the form of a ‘transatlantic debate’ with arguments from both sides [49]. Finally, regarding the increased clinical risk demonstrated in asthmatics with non-AG acidosis (accompanied by hyperchloremia) [32], it should be noted that there are several studies suggesting that hyperchloremia per se is associated with poor outcome in hospitalized and critically ill patients [50,51,52]. Hyperchloremia induced by intravenous administration of crystalloid solutions with high Cl − concentration is not to be overlooked [53,54], although there is no study investigating this issue exclusively in patients with acute severe asthma.…”
Section: Metabolic Acidosismentioning
confidence: 99%