Dear Mohammad,

 Thanks for raising this controversial topic! I beleive the recomendatio for chloride measurement is based on " saline induced iatrogenic hyperchloremic alkalosis "

Is Sodium Chloride worth its Salt????

There are some recent studies of the adverse effects that 0.9% saline  on the clinical outcome in surgical and critically ill patients when compared with balanced crystalloids.Major complications suggested increased incidence of acute kidney injury and the need for renal replacement therapy, and that  hyperchloremia may increase postoperative mortality. However, there are no large-scale randomized trials comparing 0.9% saline with balanced crystalloids.Hence I think the evidence base is weak.

But whether measuring chloride daily will be of help , is the tricky question.

Thanks and Regards,

Dr Sutirtha Chakraborty, MBBS,MD, FACB
Consultant,Dept of Biochemistry
Peerless Hospital&B.K Roy Research Center
Kolkata 700094,India
Mobile: +91 9874787638


On Tue, Apr 29, 2014 at 2:35 PM, Mohammad Al-Jubouri <[log in to unmask]> wrote:
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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--
Thanks and Regards,
Dr Sutirtha Chakraborty, MD
Consultant,Dept of Biochemistry
Peerless Hospital&B.K Roy Research Center
Kolkata 700094,India
Mobile: +91 9874787638
------ACB discussion List Information-------- This is an open discussion list for the academic and clinical community working in clinical biochemistry. Please note, archived messages are public and can be viewed via the internet. Views expressed are those of the individual and they are responsible for all message content. ACB Web Site http://www.acb.org.uk Green Laboratories Work http://www.laboratorymedicine.nhs.uk List Archives http://www.jiscmail.ac.uk/lists/ACB-CLIN-CHEM-GEN.html List Instructions (How to leave etc.) http://www.jiscmail.ac.uk/