Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation

Arch Dis Child. 2000 Dec;83(6):514-6. doi: 10.1136/adc.83.6.514.

Abstract

Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how "sick" they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid-base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit.

MeSH terms

  • Acidosis / blood
  • Acidosis / etiology*
  • Adolescent
  • Child
  • Child, Preschool
  • Chlorides / blood
  • Fluid Therapy / adverse effects*
  • Humans
  • Shock, Septic / therapy
  • Sodium Chloride / adverse effects*

Substances

  • Chlorides
  • Sodium Chloride