Concerning body fluid compartments12/28/2023 Īll of these changes in attitude and knowledge support the argument that the role of chloride in the ICU deserves more attention. At the same time, our knowledge of chloride channels has increased in the past decade with new discoveries of their crystal structures, physiological roles and their association with human diseases. This change in perception may be particularly relevant to intensivists, given that hyperchloraemia appears relatively common in intensive care unit (ICU) patients. Hyperchloraemia was thus finally seen as important for the pathogenesis of metabolic acidosis. Within the Stewart approach, chloride is the dominant negative strong ion in plasma and a key contributor to the strong ion difference (SID), one of the three independent variables that determine the hydrogen ion concentration. In the 1990s, hyperchloraemic acidosis became more thoroughly studied as the physicochemical approach (Stewart approach) to acid-base analysis began to receive wider acceptance. This progress can be traced to more than 100 years ago with the observation of a poisonous effect of sodium chloride solutions on nerve muscle preparation, followed by recognition of metabolic acidosis after saline infusion in the 1920s, and the concept of hyperchloraemic acidosis. Progress in our understanding of acid-base and chloride channel physiology, however, challenges the notion that neglecting chloride is justified. ![]() It is therefore little surprise that chloride is sometimes referred to as the forgotten electrolyte. For example, the PubMed search term 'hyperchloremia' generates 181 citations while 'hypernatremia' and 'hypercalcemia' generate 2,481 and 15,518 citations, respectively. The amount of attention chloride receives in critically ill patients, however, is limited and much less than other routinely measured electrolytes. Finally, the review examines the potential intensive care unit practice implications of a better understanding of chloride.Ĭhloride is the major strong anion in blood - accounting for approximately one-third of plasma tonicity, for 97 to 98% of all strong anionic charges and for two-thirds of all negative charges in plasma. The paper also highlights current knowledge on the impact of different types of intravenous fluids on chloride concentration and the potential effects of such changes on organ physiology. The present review summarizes key aspects of chloride physiology, including its channels, as well as the clinical relevance of disorders of chloraemia. It has also indirectly helped to generate interest in other possible effects of disorders of chloraemia. In clinical practice, interest in a physicochemical approach to acid-base physiology has directed renewed attention to chloride as a major determinant of acid-base status. New insights into its physiological roles have emerged together with progress in understanding the structures and functions of chloride channels. Yet chloride has received less attention than any other ion in the critical care literature. Its concentration is frequently abnormal in intensive care unit patients, often as a consequence of fluid therapy. ![]() Chloride is the principal anion in the extracellular fluid and is the second main contributor to plasma tonicity.
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