The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic aci...The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.展开更多
Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors,surgical injury,inflammatory disorders such as tuberculosis infection,radiotherapy and less commonly diverticulum of the urinary tr...Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors,surgical injury,inflammatory disorders such as tuberculosis infection,radiotherapy and less commonly diverticulum of the urinary tract.The fistula is often identified by urinary tract abnormalities such as dysuria,recurrent urinary tract infection,pneumaturia,and fecaluria.Here,we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin,presenting with severe acute diarrhea,metabolic acidosis,hyperchloremia and hypokalemia while with only mild urinary tract symptoms.The patient was cured by tuberculostatic therapy.展开更多
目的评价在重症监护室危重症患者中高氯血症对急性肾损伤的影响。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普数据库从建库至2022年9月29日公开发表的关于高氯血症与危重症患者结局相关的文献。...目的评价在重症监护室危重症患者中高氯血症对急性肾损伤的影响。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普数据库从建库至2022年9月29日公开发表的关于高氯血症与危重症患者结局相关的文献。利用文献提供的调整或未调整的优势比(OR)及95%置信区间(95%CI)统计量,应用R语言软件进行Meta分析。结果共纳入文献15篇,包括29005例患者。Meta分析结果显示危重症患者入住重症监护室后高氯血症发生率为43%(OR=0.43,95%CI:0.30~0.56),发生高氯血症的危重症患者急性肾损伤发生风险明显增加(OR=1.35,95%CI:1.10~1.64,P<0.01),敏感性分析显示结果稳健。结论危重症患者高氯血症与急性肾损伤发生有显著相关性。展开更多
Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in in...Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to 2012.Inclusion criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline treatment.Serum chloride perturbation within 72 h of admission was evaluated as a predictor of outcomes.The increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day mortality.Results:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were included.The overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of patients.The prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,respectively.After adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI groups.Conclusions:An increase in chloride from baseline is common in adult patients with ICH admitted to ICU.The increase is significantly associated with elevated mortality.These results support the significance of diligently monitoring chloride levels in these patients.展开更多
文摘The purpose of this review is to objectively evaluate the biochemical and pathophysiological properties of 0.9% saline （henceforth： saline） and to discuss the impact of saline infusion, specifically on systemic acid-base bal- ance and renal hemodynamics. Studies have shown that electrolyte balance, including effects of saline infusion on serum electrolytes, is often poorly understood among practicing physicians and inappropriate saline prescribing can cause increased morbidity and mortality. Large-volume （〉2 L） saline infusion in healthy adults induces hyperohloremia which is associated with metabolic acidosis, hyperkalemia, and negative protein balance. Saline overload （80 ml/kg） in rodents can cause intestinal edema and contractile dysfunction associated with activation of sodium-proton exchanger （NHE） and decrease in myosin light chain phosphorylation. Saline infusion can also adversely affect renal hemody- namics. Microperfusion experiments and real-time imaging studies have demonstrated a reduction in renal perfusion and an expansion in kidney volume, compromising 02 delivery to the renal perenchyma following saline infusion. Clinically, saline infusion for patients post abdominal and cardiovascular surgery is associated with a greater number of adverse effects including more frequent blood product transfusion and bicarbonate therapy, reduced gastric blood flow, delayed recovery of gut function, impaired cardiac contractility in response to inotropes, prolonged hospital stay, and possibly increased mortality. In critically ill patients, saline infusion, compared to balanced fluid infusions, in- creases the occurrence of acute kidney injury. In summary, saline is a highly acidic fluid. With the exception of saline infusion for patients with hypochloremic metabolic alkalosis and volume depletion due to vomiting or upper gastroin- testinal suction, indiscriminate use, especially for acutely ill patients, may cause unnecessary complications and should be avoided. More education regarding saline-related effects and adequate electrolyte management is needed.
基金Supported by National Natural Science Foundation of China,No.81272640Guangdong Science and Technology Program,No.2010B031200008 and No.2012B031800043
文摘Acquired vesico-rectal fistula is an uncommon complication of pelvic malignant tumors,surgical injury,inflammatory disorders such as tuberculosis infection,radiotherapy and less commonly diverticulum of the urinary tract.The fistula is often identified by urinary tract abnormalities such as dysuria,recurrent urinary tract infection,pneumaturia,and fecaluria.Here,we report an unusual case of a patient with a vesico-rectal fistula of tuberculous origin,presenting with severe acute diarrhea,metabolic acidosis,hyperchloremia and hypokalemia while with only mild urinary tract symptoms.The patient was cured by tuberculostatic therapy.
文摘目的评价在重症监护室危重症患者中高氯血症对急性肾损伤的影响。方法检索PubMed、Embase、Cochrane Library、Web of Science、中国知网、万方、维普数据库从建库至2022年9月29日公开发表的关于高氯血症与危重症患者结局相关的文献。利用文献提供的调整或未调整的优势比(OR)及95%置信区间(95%CI)统计量,应用R语言软件进行Meta分析。结果共纳入文献15篇,包括29005例患者。Meta分析结果显示危重症患者入住重症监护室后高氯血症发生率为43%(OR=0.43,95%CI:0.30~0.56),发生高氯血症的危重症患者急性肾损伤发生风险明显增加(OR=1.35,95%CI:1.10~1.64,P<0.01),敏感性分析显示结果稳健。结论危重症患者高氯血症与急性肾损伤发生有显著相关性。
基金supported by the Foundation of Beijing Tongren Hospital,Capital Medical University(No.2021-YJJ-ZZL-026).
文摘Background:Hyperchloremia is associated with increased mortality in critically ill patients.The objective of this study was to investigate the association between increased chloride levels and mortality outcomes in intracerebral hemorrhage(ICH)patients admitted to the intensive care unit(ICU).Methods:We performed a retrospective study of all patients diagnosed with ICH and included in the Medical Information Mart for Intensive Care(MIMIC-III)from 2001 to 2012.Inclusion criteria were the first diagnosis of ICH,ICU length of stay(LOS)over 72 h,and not receiving hypertonic saline treatment.Serum chloride perturbation within 72 h of admission was evaluated as a predictor of outcomes.The increase in chloride from baseline was dichotomized based on an increase in chloride in 72 h(≤5 mmol/L or>5 mmol/L).The primary outcome was 90-day mortality.Results:A total of 376 patients(54.5%male,median age 70 years,interquartile range:58–79 years)were included.The overall 90-day mortality was 32.2%(n=121),in-hospital mortality was 25.8%(n=97),and Day 2 acute kidney injury(AKI)occurred in 29.0%(n=109)of patients.The prevalence of hyperchloremia on admission,during the first 72 h,and an increase in chloride(>5 mmol/L)were 8.8%,39.4%,and 42.8%,respectively.After adjusting for confounders,the hazard ratio of increase in chloride(>5 mmol/L)was 1.66(95%confidence interval:1.05–2.64,P=0.031).An increase in chloride(>5 mmol/L)was associated with a higher odds ratio for 90-day mortality in both the AKI and non-AKI groups.Conclusions:An increase in chloride from baseline is common in adult patients with ICH admitted to ICU.The increase is significantly associated with elevated mortality.These results support the significance of diligently monitoring chloride levels in these patients.
