From the Guidelines
A chloride level of 111 mmol/L indicates hyperchloremia, which is associated with increased 30-day mortality and major adverse kidney events, particularly when caused by administration of large volumes of 0.9% saline. This condition can lead to hyperchloraemic acidosis, renal vasoconstriction, and acute kidney injury (AKI) 1. Hyperchloremia is often seen in patients undergoing noncardiac surgery, with approximately 20% of patients developing this condition, which is linked to a higher risk of complications and mortality 1. The use of buffered crystalloids instead of 0.9% saline has been shown to reduce the risk of major adverse kidney events and other complications in critically ill patients and those undergoing major abdominal surgery 1.
Key points to consider in the management of hyperchloremia include:
- Identifying and addressing the underlying cause, such as dehydration or the use of certain medications like IV saline solutions
- Monitoring electrolyte levels, particularly sodium and bicarbonate, as these often shift together with chloride
- Considering the use of buffered intravenous solutions instead of 0.9% saline in the perioperative period to minimize the risk of hyperchloraemic acidosis and AKI 1
- Recognizing that hyperchloremia can be a sign of an underlying condition that requires medical attention, such as kidney problems or endocrine disorders.
It is essential to discuss the elevated chloride level with a healthcare provider to determine the best course of action and to interpret the result in the context of overall health and other electrolyte levels 1.
From the Research
Hyperchloremia Indications
- Hyperchloremia, or elevated chloride levels, has been associated with various health issues, including acute kidney injury (AKI) and chronic kidney disease (CKD) progression 2, 3, 4, 5.
- A study found that higher serum chloride concentrations are associated with AKI in unselected critically ill patients, with a maximum chloride value of 111.8 ± 8.1 mmol/l in AKI patients compared to 107.9 ± 5.4 mmol/l in non-AKI patients 5.
- Another study discovered that higher serum chloride associated with a modestly steeper rate of estimated glomerular filtration rate (eGFR) decline in CKD patients, suggesting that serum chloride may be a useful biomarker to predict CKD progression 4.
- In contrast, a study on pre-dialysis CKD patients found that low serum chloride levels were associated with increased mortality and risk of cardiovascular events, while higher chloride levels (up to 106.0 mEq/L) were associated with lower risk of these outcomes 6.
Key Findings
- Elevated chloride levels, such as 111 mEq/L, may indicate an increased risk of AKI and CKD progression 2, 3, 4, 5.
- The association between serum chloride levels and health outcomes may vary depending on the population and context, with both high and low chloride levels potentially being associated with adverse outcomes 5, 6.
- Further research is needed to fully understand the relationship between serum chloride levels and kidney function, as well as to determine the optimal range for serum chloride in different patient populations 2, 3, 4.