• Alison T Lai, Michelle P Zeller, Tina Millen, Peter Kavsak, Wojciech Szczeklik, Allahna Elahie, Waleed Alhazzani, Frederick D'Aragon, Roman Jaeschke, Francois Lamontagne, Timothy Karachi, Deborah Cook, Maureen Meade, Bram Rochwerg, and Canadian Critical Care Trials Group.
• Department of Medicine, McMaster University, Hamilton, ON, Canada.
• Crit. Care Med. 2018 Apr 1; 46 (4): e326-e329.

ObjectiveUse of hyperchloremic IV fluids for resuscitation in sepsis may be associated with increased mortality and use of renal replacement therapy. After crystalloids, 5% human albumin represents the second most common resuscitation fluid in the ICU. Its chloride concentration is rarely considered in the clinical setting. This study quantifies previously undocumented chloride concentrations of three 5% albumin solutions using biochemical analysis.DesignWe performed blinded analysis of the electrolyte concentration of albumin samples obtained directly from the national blood supplier (Canadian Blood Services). Two-tailed independent t tests were performed for all possible comparative analyses. Analysis of variance testing was performed for relevant three-way comparisons. Significance threshold was set at p less than 0.05.SettingAll samples were analyzed in the core laboratory at an academic hospital associated with McMaster University in Hamilton, Ontario, Canada.SubjectsWe analyzed 65 albumin samples from three available brands obtained through Canadian Blood Services. They include Plasbumin (n = 21), Alburex (n = 24), Octalbin (n = 20).InterventionLaboratory technologists blinded to product identification measured the concentration of electrolytes, extended electrolytes, lactate, and albumin of each sample using the Abbott ARCHITECT c8000 chemistry analyzer.Measurements And Main ResultsThe mean chloride concentration of Plasbumin, Alburex, and Octalbin, respectively, were 109.4 mmol/L (SD, 1.3), 123.6 mmol/L (SD, 1.3), and 136.8 mmol/L (SD, 0.4). The mean sodium concentration of Plasbumin, Alburex, and Octalbin, respectively, were 139.6 mmol/L (SD, 1.6), 137.3 mmol/L (SD, 2.2), and 149.4 mmol/L (SD, 0.5). The chloride and sodium concentration differed significantly for all two-way comparisons (p < 0.0001) and multiple comparison testing (p < 0.0001).ConclusionThis study is the first to identify and document a statistically significant variability in the chloride concentration of available 5% albumin products. This study has also informed a pilot randomized controlled trial examining the effect of administering high chloride versus low chloride fluids in critically ill patients with sepsis.

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