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Saline-induced Hyperchloremic Metabolic Acidosis and Clinical Outcomes in Critically ill Patients

PI: John A. Kellum, MD

Co-Investigators: Gilles Clermont, MD, Raghavan Murugan, MD, Lan Kong, PhD

Funding: Baxter Healthcare Corporation

Hyperchloremic metabolic acidosis (HCA) is a common complication arising secondary to large-volume (saline) resuscitation (LVR) in patients.  Several large clinical studies have documented the development of HCA during critical illness but none could adequately evaluate the impact of HCA on patient clinical outcomes.  At present, 0.9% saline is the standard of care for volume resuscitation of critically ill patients throughout the world.  However, data from animal experiments indicate that HCA is associated with hemodynamic instability, development of renal dysfunction, inflammatory response induction and decreased survival.

Our preliminary clinical data also suggest that HCA is associated with prolonged hospitalization, greater number of days in the intensive care unit (ICU) and increased mortality compared to standardized intensive care unit mortality rates. Using a large dataset of critically ill patients from the intensive care units (ICUs) at the University of Pittsburgh Medical Center we will assess the incidence of HCA, the association between HCA and development of acute kidney injury (AKI), and the association between HCA and adverse clinical outcomes. This study will help investigators ascertain the relative effect of HCA on clinical endpoints so that future development of resuscitation fluids can be better informed.