One might ask
1) How much fluid with "high" NaCl do they need to receive to necessitate monitoring?
2) Why should patients be receiving large volumes of 0.9% NaCl unless they have large Gastrointestinal tract fluid losses e.g. fistula, short bowel, diarrhoea, vomiting? (Note: Normal Na requirement is approx 1mmol/kg/day. Thus a 70 kg person needs approx 70 mmol Na per day. 1 litre 0.9% saline contains 154 mmol - approx twice requirement. Shouldn't they be receiving most of their fluid in other forms?)
Michael
-----Original Message-----
From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Ben Jones
Sent: 28 May 2013 11:30
To: [log in to unmask]
Subject: Re: chloride
From the guideline (p73):
"Hyperchloraemia is a recognised consequence of the intravenous fluid therapy and there is some evidence in the literature suggesting that it may be associated with higher levels of mortality and morbidity due to development of hyperchloraemic acidosis or reduced renal perfusion and glomerular filtration rates"
After considering the evidence they recommend:
"If patients have received IV fluids containing chloride concentrations greater than 120 mmol/l (for example, sodium chloride 0.9%), monitor the serum chloride concentration daily, and if patients develop hyperchloraemia or acidaemia, reassess their IV fluid prescription and assess their acid-base status. Consider less frequent monitoring for patients who are stable."
On 28 May 2013, at 11:25, Jonathan Kay <[log in to unmask]> wrote:
> Not in Oxford, and not in lots of other places IIRC the relevant Keele benchmarking survey.
>
> Does NICE suggest why?
>
> Jonathan
>
> On 28 May 2013, at 10:57, Ben Jones wrote:
>
>> The recent draft NICE guidelines on iv fluid resuscitation mention measuring chloride on all patients receiving normal saline (p36). Our lab includes this in the routine U+E panel, but does everyone else?
>
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