• Heidi M Riha, Michael J Erdman, Joseph E Vandigo, Lauren A Kimmons, Nitin Goyal, K Erin Davidson, Abhi Pandhi, and G Morgan Jones.
• 1Department of Pharmacy, Methodist University Hospital, Memphis, TN. 2Department of Pharmacy, University of Florida Health, Jacksonville, FL. 3Department of Pharmaceutical Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD. 4Department of Clinical Pharmacy, University of Tennessee Health Sciences Center, Memphis, TN. 5Department of Neurology, University of Tennessee Health Sciences Center, Memphis, TN. 6Departments of Clinical Pharmacy, Neurology, and Neurosurgery, University of Tennessee Health Sciences Center, Memphis, TN.
• Crit. Care Med. 2017 Sep 1; 45 (9): e947-e953.

ObjectivesHyperchloremia has been associated with increased morbidity and mortality in critically ill patients. While previous research has demonstrated an association between hypertonic saline and hyperchloremia, limited data exist in neurocritical care patients. The objective of this study is to determine the impact of moderate hyperchloremia (chloride ≥ 115 mmol/L) on clinical outcomes in intracerebral hemorrhage patients treated with continuous IV infusion 3% hypertonic saline.DesignMulticenter, retrospective, propensity-matched cohort study.SettingNeurocritical care units at two academic medical centers with dedicated neurocritical care teams and comprehensive stroke center designation.PatientsIntracerebral hemorrhage patients discharged between September 2011 and September 2015 were evaluated and matched 1:1 based on propensity scoring.InterventionsContinuous IV infusion 3% hypertonic saline.Measurements And Main ResultsA total of 219 patients were included in the unmatched cohort (143 moderate hyperchloremia and 76 nonhyperchloremia) and 100 patients in the propensity-matched cohort. In-hospital mortality was significantly higher in those who developed moderate hyperchloremia in a propensity-matched cohort (34% vs 14%; p = 0.02). Moderate hyperchloremia independently predicted in-hospital mortality in multivariable logistic regression analysis (odds ratio, 4.4 [95% CI, 1.4-13.5]; p = 0.01).ConclusionsWe observed higher rates of in-hospital mortality in patients who developed moderate hyperchloremia during treatment with continuous IV infusion 3% hypertonic saline, with moderate hyperchloremia independently predicting in-hospital mortality. These results suggest that chloride values should be monitored closely during hypertonic saline treatment as moderate elevations may impact outcomes in intracerebral hemorrhage patients.

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