Managing Chloride and Bicarbonate in the Prevention and Treatment of Acute Kidney Injury
| Autor: | Ryan W Haines, John R. Prowle, Christopher J. Kirwan |
|---|---|
| Rok vydání: | 2019 |
| Předmět: |
0301 basic medicine
medicine.medical_specialty Bicarbonate medicine.medical_treatment 030232 urology & nephrology law.invention 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Randomized controlled trial Chlorides law Hyperchloremic acidosis medicine Humans Intensive care medicine Saline Sodium bicarbonate business.industry Acute kidney injury Metabolic acidosis Crystalloid Solutions Acute Kidney Injury medicine.disease Bicarbonates 030104 developmental biology chemistry Nephrology Renal physiology business Acidosis |
| Zdroj: | Seminars in nephrology. 39(5) |
| ISSN: | 1558-4488 |
| Popis: | Intravenous crystalloid therapy is one of the most ubiquitous aspects of hospital and critical care medicine. In recent years, there has been increasing focus on the electrolyte composition, and particularly chloride content, of crystalloid solutions. This has led to increasing clinical adoption of balanced solutions, containing substrates for bicarbonate generation and consequently a lower chloride content, in place of 0.9% saline. In this article we review the physiochemical rationale for avoidance of 0.9% saline and the effects of hyperchloremic acidosis on renal physiology. Finally, we review the current evidence and rationale for use of balanced solutions greater than 0.9% saline in acutely ill patients in a variety of clinical settings, as well as considering the role for sodium bicarbonate in preventing or correcting metabolic acidosis. In conclusion, there is a strong physiological rationale for avoidance of iatrogenic hyperchloremic acidosis from 0.9% saline administration in acutely unwell patients and an association with adverse renal outcomes in several studies. However, evidence from large definitive multicenter randomized trials is not yet available to establish the dose-relationship between 0.9% saline administration and potential harm and inform us if some 0.9% saline use is acceptable or if any exposure confers harm. |
| Databáze: | OpenAIRE |
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