Sodium and Chloride Balance in Critically Ill Patients

Abstract

AbstractThis chapter discusses the importance of sodium and chloride balance in critically ill patients. Infusion of high amounts of chloride is associated with hyperchloremia and metabolic acidosis, while hypernatremia and hyperchloremia are associated with adverse outcomes. The use of 0.9% sodium chloride is not ideal as it results in a rise in serum chloride, and in brain-injured patients, large volumes of hypotonic solutions must be avoided to prevent cerebral swelling and intracranial hypertension. The use of ‘balanced’ solutions is suggested to reduce the development of hyperchloremic acidosis in brain-injured patients. Chloride is a key contributor to the strong ion difference (SID), and alterations in the chloride balance can have negative implications on acid-base status, renal function, and haemostasis. Further research is needed to understand the clinical consequences of disorders of chloride balance and concentration.