Journal Article

Serum chloride concentration and outcomes in adults receiving intravenous fluid therapy with a balanced crystalloid solution or 0.9% sodium chloride

Devaux, Anthony, Young, Paul J., Myburgh, John, Ramanan, Mahesh, Li, Qiang, Finfer, Simon, Billot, Laurent, Delaney, Anthony, Micallef, Sharon, Venkatesh, Balasubramanian, Hammond, Naomi

2025

Overview

Purpose To determine whether there is an interaction between baseline serum chloride concentration and pH and treatment effects in Intensive Care Unit (ICU) patients receiving intravenous fluid therapy with balanced solution versus 0.9% sodium chloride (saline). Methods A secondary analysis of a randomized controlled trial in which patients were divided into cohorts according to quartiles of baseline serum chloride concentration and pH. The primary outcome was day-90 mortality. Results From 4846 patients with outcome data available, 4823 with relevant baseline data were included in this analysis, with 1347, 1333, 993 and 1150 patients in the chloride quartiles of < 102, 102–106, 107–109 and > 109 mmol/L, respectively. Data were also analysed in pH quartiles of ≤ 7.27, 7.27–7.34, 7.34–7.39 and > 7.39. The risk-adjusted odds ratio (95% confidence interval [CI]) for day-90 mortality for patients assigned balanced solution compared to saline was 1.23 (0.95–1.58), 0.95 (0.73–1.25), 0.88 (0.64–1.21), and 0.76 (0.57–1.01) for lowest to highest chloride subgroups, respectively ( P value for interaction = 0.10), and 0.89 (95% CI 0.69–1.15), 0.94 (0.70–1.27), 0.96 (0.67–1.38) and 1.15 (0.82–1.60) for pH quartiles from lowest to highest, respectively ( P value for interaction = 0.63). Conclusions There were no significant differences in the treatment effect of balanced solutions compared to saline according to baseline serum chloride concentration or pH.

• Publisher: Springer Berlin Heidelberg,Springer,Springer Nature B.V
• Subject: Adult / Aged / Anesthesiology / Chemical properties / Chloride / Chlorides / Chlorides - blood / Comparative analysis / Critical Care Medicine / Crystalloid Solutions - administration & dosage / Crystalloid Solutions - therapeutic use / Dichloropropane / Emergency Medicine / Female / Fluid therapy / Fluid Therapy - methods / Health aspects / Humans / Hydration / Hydrogen-Ion Concentration / Infusions, Intravenous / Intensive / Intensive Care Units / Intravenous administration / Intravenous therapy / Male / Measurement / Medicine / Medicine & Public Health / Methods / Middle Aged / Mortality / Original / Osmoregulation / Pain Medicine / Patient outcomes / Pediatrics / pH effects / Physiologic salines / Physiological aspects / Pneumology/Respiratory System / Quartiles / Saline Solution - administration & dosage / Saline Solution - therapeutic use / Sodium chloride / Sodium Chloride - therapeutic use / Subgroups / Treatment Outcome / Water-electrolyte balance (Physiology)