Okay, my rant:
I find it difficult to understand that blanket serum chloride measurement daily on all patients receiving IV fluid therapy has a sound reasoning. If IV 0.9% sodium chloride is being given for restoration of extracellular volume depletion, then serum chloride measurement may deter from giving the required volume of fluid to restore organ perfusion. If IV 0.9% NaCl is being given for maintenance therapy then there may be some reasoning behind using high serum chloride as a marker of excessive saline infusion, although judicious fluid prescription in the first place and regular review of fluid & electrolytes requirement pertinent to the patient’s clinical needs, should avoid this. It is not the chloride load from excessive saline therapy that matters only but also the excessive sodium load, that may not be apparent on measuring serum sodium concentration, especially in patients with compromised cardiac, renal or hepatic functions. Therefore I am not sure
that measuring serum chloride daily is going to help optimising fluid therapy.
Mohammad
--------------------------------------------
On Tue, 29/4/14, Mohammad Al-Jubouri <[log in to unmask]> wrote:
Subject: NICE CG174
To: [log in to unmask]
Date: Tuesday, 29 April, 2014, 8:23
NICE IV fluid guidance (CG174)
published in Dec 2013 states that:
"If patients have received IV fluids containing chloride
concentrations greater than 120 mmol/l (for example, sodium
chloride 0.9%), monitor their serum chloride concentration
daily"
Is this decree about using a biocemical measure to deter
excessive use of 0.9% sodium chloride, or is there an
evidence for improved outcome if serum chloride is measured
daily in such situation?
All sensible and insensible answers are welcome.
Regards
Mohammad
Dr. M A Al-Jubouri, MB ChB, MSc, EurClinChem, FRCP Edin,
FRCPath
Consultant Chemical Pathologist
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