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Original Articles
Urinary strong ion difference is a major determinant of plasma chloride concentration changes in postoperative patients
Rev Bras Ter Intensiva. 2013;25(3):197-204
Abstract
Original ArticlesUrinary strong ion difference is a major determinant of plasma chloride concentration changes in postoperative patients
Rev Bras Ter Intensiva. 2013;25(3):197-204
DOI 10.5935/0103-507X.20130035
Views1See moreOBJECTIVE:
To show that alterations in the plasma chloride concentration ([Cl–]plasma) during the postoperative period are largely dependent on the urinary strong ion difference ([SID]urine=[Na+]urine+[K+]urine-[Cl-]urine) and not on differences in fluid therapy.
METHODS:
Measurements were performed at intensive care unit admission and 24 hours later in a total of 148 postoperative patients. Patients were assigned into one of three groups according to the change in [Cl–]plasma at the 24 hours time point: increased [Cl–]plasma (n=39), decreased [Cl–]plasma (n=56) or unchanged [Cl–]plasma (n=53).
RESULTS:
On admission, the increased [Cl–]plasma group had a lower [Cl–]plasma (105±5 versus 109±4 and 106±3mmol/L, p<0.05), a higher plasma anion gap concentration ([AG]plasma) and a higher strong ion gap concentration ([SIG]). After 24 hours, the increased [Cl–]plasma group showed a higher [Cl–]plasma (111±4 versus 104±4 and 107±3mmol/L, p<0.05) and lower [AG]plasma and [SIG]. The volume and [SID] of administered fluids were similar between groups except that the [SID]urine was higher (38±37 versus 18±22 and 23±18mmol/L, p<0.05) in the increased [Cl–]plasma group at the 24 hours time point. A multiple linear regression analysis showed that the [Cl–]plasma on admission and [SID]urine were independent predictors of the variation in [Cl–]plasma 24 hours later.
CONCLUSIONS:
Changes in [Cl–]plasma during the first postoperative day were largely related to [SID]urine and [Cl–]plasma on admission and not to the characteristics of the infused fluids. Therefore, decreasing [SID]urine could be a major mechanism for preventing the development of salineinduced hyperchloremia.
Views1Abstract
Original ArticlesUrinary strong ion difference is a major determinant of plasma chloride concentration changes in postoperative patients
Rev Bras Ter Intensiva. 2013;25(3):197-204
DOI 10.5935/0103-507X.20130035
Views1See moreOBJECTIVE:
To show that alterations in the plasma chloride concentration ([Cl–]plasma) during the postoperative period are largely dependent on the urinary strong ion difference ([SID]urine=[Na+]urine+[K+]urine-[Cl-]urine) and not on differences in fluid therapy.
METHODS:
Measurements were performed at intensive care unit admission and 24 hours later in a total of 148 postoperative patients. Patients were assigned into one of three groups according to the change in [Cl–]plasma at the 24 hours time point: increased [Cl–]plasma (n=39), decreased [Cl–]plasma (n=56) or unchanged [Cl–]plasma (n=53).
RESULTS:
On admission, the increased [Cl–]plasma group had a lower [Cl–]plasma (105±5 versus 109±4 and 106±3mmol/L, p<0.05), a higher plasma anion gap concentration ([AG]plasma) and a higher strong ion gap concentration ([SIG]). After 24 hours, the increased [Cl–]plasma group showed a higher [Cl–]plasma (111±4 versus 104±4 and 107±3mmol/L, p<0.05) and lower [AG]plasma and [SIG]. The volume and [SID] of administered fluids were similar between groups except that the [SID]urine was higher (38±37 versus 18±22 and 23±18mmol/L, p<0.05) in the increased [Cl–]plasma group at the 24 hours time point. A multiple linear regression analysis showed that the [Cl–]plasma on admission and [SID]urine were independent predictors of the variation in [Cl–]plasma 24 hours later.
CONCLUSIONS:
Changes in [Cl–]plasma during the first postoperative day were largely related to [SID]urine and [Cl–]plasma on admission and not to the characteristics of the infused fluids. Therefore, decreasing [SID]urine could be a major mechanism for preventing the development of salineinduced hyperchloremia.
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