Thursday, March 13, 2014

Hyperchloremia and outcomes after noncardiac surgery

From a recent study:

BACKGROUND: The use of normal saline is associated with hyperchloremic metabolic acidosis...
RESULTS: The dataset consisted of 22,851 surgical patients with normal preoperative serum chloride concentration and renal function..Of the 4955 patients with hyperchloremia after surgery, 4266 (85%) patients were matched to patients who had normal serum chloride levels after surgery. These 2 groups were well balanced with respect to all variables collected. The hyperchloremic group was at increased risk of mortality at 30 days postoperatively (3.0% vs 1.9%; odds ratio = 1.58; 95% confidence interval, 1.25–1.98) (relative risk 1.6 or risk increase of 1.1%) and had a longer hospital stay (7.0 days [interquartile range 4.1–12.3] compared with 6.3 [interquartile range 4.0–11.3]) than patients with normal postoperative serum chloride levels. Patients with postoperative hyperchloremia were more likely to have postoperative renal dysfunction. Using all preoperative variables and measured outcome variables in a logistic regression analysis, hyperchloremia remained an independent predictor of 30-day mortality with an odds ratio of 2.05 (95% confidence interval, 1.62–2.59).

Maybe the surgeons have been right all along.

As the blogger at RESUS.ME put it:

Here’s something to add to the pile of data cautioning us to think before we acidify patients with saline.

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