Physiological effects of hyperchloraemia and acidosis

• Published in: British journal of anaesthesia : BJA Vol. 101; no. 2; pp. 141 - 150
• Main Authors: Handy, J.M., Soni, N.
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Ltd 01.08.2008; Oxford University Press; Oxford Publishing Limited (England)
• Subjects: Acid-Base Equilibrium; acidosis; Acidosis - complications; Acidosis - physiopathology; acid–base equilibrium, metabolic acidosis; Anesthesia; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Biological and medical sciences; Chlorides - blood; complications; complications, acidosis; Diabetic Ketoacidosis - physiopathology; Exercise - physiology; Fluid Therapy; fluids; fluids, i.v; Humans; i.v; intracellular; ions; ions, intracellular; lactate; Medical sciences; metabolic acidosis; metabolism; metabolism, lactate; complications, acidosis; fluids, i.v; metabolism, lactate; acid–base equilibrium, metabolic acidosis; ions, intracellular; Hydroelectrolytic balance disorder; acid-base equilibrium; intracellular; metabolism; Chlorine; Ions; Metabolism; Inorganic element; acidosis; fluids; Lactates; Metabolic disorder; Hyperchloremia; Anesthesia; Complication; Lactic acid; i.v.; ions; lactate; Metabolic acidosis; metabolic acidosis; complications
• ISSN: 0007-0912; 1471-6771
• DOI: 10.1093/bja/aen148

The advent of balanced solutions for i.v. fluid resuscitation and replacement is imminent and will affect any specialty involved in fluid management. Part of the background to their introduction has focused on the non-physiological nature of ‘normal’ saline solution and the developing science about the potential problems of hyperchloraemic acidosis. This review assesses the physiological significance of hyperchloraemic acidosis and of acidosis in general. It aims to differentiate the effects of the causes of acidosis from the physiological consequences of acidosis. It is intended to provide an assessment of the importance of hyperchloraemic acidosis and thereby the likely benefits of balanced solutions.