Abstract：
OBJECTIVE: The purpose of this therapeutic update is to provide pharmacists with a general overview of the pathophysiology of hyperchloremia and describe strategies to help prevent development of this electrolyte abnormality in hospitalized patients.
CONCLUSIONS: Hyperchloremia is an electrolyte abnormality associated with an increased incidence of acute kidney injury and metabolic acidosis. Intravenous (IV) fluids utilized for volume resuscitation, medication diluents, and total parental nutrition all may contribute to the development of hyperchloremia. Current evidence suggests that administration of balanced crystalloids for either fluid resuscitation or maintenance fluids may impact serum chloride levels and patient outcomes. In multiple randomized controlled trials, administering balanced crystalloids for fluid resuscitation in critically ill patient populations did not decrease mortality. However, further analyses of subpopulations within these trials have demonstrated that patients with sepsis may benefit from receiving balanced crystalloids for initial fluid resuscitation. Results from several small studies suggest that altering the composition of these IV fluids may help prevent development of hyperchloremia.
CONCLUSIONS: Management of hyperchloremia is preventative in nature and can be mitigated through management of resuscitation fluids, medication diluents, and total parenteral nutrition. Inpatient pharmacists should be aware of the potential risk of fluid-associated hyperchloremia and assist with optimal fluid management to prevent and manage hyperchloremia.
CONCLUSIONS: Hyperchloremia is an electrolyte abnormality associated with an increased incidence of acute kidney injury and metabolic acidosis. Intravenous (IV) fluids utilized for volume resuscitation, medication diluents, and total parental nutrition all may contribute to the development of hyperchloremia. Current evidence suggests that administration of balanced crystalloids for either fluid resuscitation or maintenance fluids may impact serum chloride levels and patient outcomes. In multiple randomized controlled trials, administering balanced crystalloids for fluid resuscitation in critically ill patient populations did not decrease mortality. However, further analyses of subpopulations within these trials have demonstrated that patients with sepsis may benefit from receiving balanced crystalloids for initial fluid resuscitation. Results from several small studies suggest that altering the composition of these IV fluids may help prevent development of hyperchloremia.
CONCLUSIONS: Management of hyperchloremia is preventative in nature and can be mitigated through management of resuscitation fluids, medication diluents, and total parenteral nutrition. Inpatient pharmacists should be aware of the potential risk of fluid-associated hyperchloremia and assist with optimal fluid management to prevent and manage hyperchloremia.
摘要：
目的：本次治疗更新的目的是为药师提供高氯血症的病理生理学概述，并描述帮助预防住院患者电解质异常发展的策略。
结论：高氯血症是一种电解质异常，与急性肾损伤和代谢性酸中毒的发生率增加有关。用于容量复苏的静脉（IV）液体，药物稀释剂，和父母的总营养都可能导致高氯血症的发展。目前的证据表明，用于液体复苏或维持液的平衡晶体可能会影响血清氯化物水平和患者预后。在多项随机对照试验中，在危重患者人群中给予平衡晶体液以进行液体复苏并没有降低死亡率.然而,对这些试验中的亚群的进一步分析表明,脓毒症患者接受平衡晶体液以进行初始液体复苏可能会获益.一些小型研究的结果表明，改变这些静脉输液的成分可能有助于防止高氯血症的发展。
结论：高氯血症的管理本质上是预防性的，可以通过复苏液的管理来缓解，药物稀释剂，和全胃肠外营养。住院药剂师应意识到液体相关高氯血症的潜在风险，并协助进行最佳的液体管理以预防和管理高氯血症。
结论：高氯血症是一种电解质异常，与急性肾损伤和代谢性酸中毒的发生率增加有关。用于容量复苏的静脉（IV）液体，药物稀释剂，和父母的总营养都可能导致高氯血症的发展。目前的证据表明，用于液体复苏或维持液的平衡晶体可能会影响血清氯化物水平和患者预后。在多项随机对照试验中，在危重患者人群中给予平衡晶体液以进行液体复苏并没有降低死亡率.然而,对这些试验中的亚群的进一步分析表明,脓毒症患者接受平衡晶体液以进行初始液体复苏可能会获益.一些小型研究的结果表明，改变这些静脉输液的成分可能有助于防止高氯血症的发展。
结论：高氯血症的管理本质上是预防性的，可以通过复苏液的管理来缓解，药物稀释剂，和全胃肠外营养。住院药剂师应意识到液体相关高氯血症的潜在风险，并协助进行最佳的液体管理以预防和管理高氯血症。
