低氯晶体液研究.pdf

MUNICATIONAssociation Between a Chloride-Liberalvs Chloride-Restrictive Intravenous FluidAdministration Strategy and Kidney Injuryin Critically Ill AdultsNor’azim Mohd Yunos, MDRinaldo Bellomo, MD, FCICMColin Hegarty, BScDavid Story, MDLisa Ho, MClinPharmMichael Bailey, PhDTHE ADMINISTRATION OF INTRA-venous chloride is ubiquitousin critical care ,2Inaddition, many of the fluidsused for hydration and resuscitationcontain supraphysiological concentra-tions of chloride,3-5which induce or ex-acerbate hyperchloremia and meta-bolic acidosis,6,7may cause renalvasoconstriction and decreased glo-merular filtration rate (GFR),8-10pro-long time to first micturition,11and de-crease urine output in major , in a double-blind random-ized controlled trial,2Lofsaline de-creased cortical perfusion in humanstudy pared withPlasma- effects of chlo-ride on the kidney are of potential con-cern because acute kidney injury (AKI)is associated with high mortality14andmay require treatment with costly andinvasive renal replacement therapy(RRT).15,16Given the high risk of AKI in criti-cally ill patients and the experimental as-sociation between chloride administra-tion and decreased renal function, wehypothesized that a chloride-restric-tive intravenous fluids strategy in criti-cally ill patients might be associated withFor ment see p Affiliations:Johor B