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Chasing the base deficit: hyperchloraemic acidosis following 0.9% saline fluid resuscitation
  1. S Skellett,
  2. A Mayer,
  3. A Durward,
  4. S M Tibby,
  5. I A Murdoch
  1. Paediatric Intensive Care Unit, Guy's and St Thomas' Hospital, London SE1 9RT, UK
  1. Dr Durwardadurward{at}


Base deficit is a parameter often used to guide further treatment in acidotic children and is taken as a measure of how “sick” they are. Five children with septic shock are presented who had persisting base deficit after large volume resuscitation with 0.9% saline. Stewart's strong ion theory of acid–base balance is able to quantify the causes of metabolic acidosis and is used to show that our patients had a hyperchloraemic metabolic acidosis. We show how the chloride content of the saline loads given to our patients caused this hyperchloraemia. It is concluded that 0.9% saline and other chloride rich fluids may not be ideal resuscitation fluids; if used, clinicians must be aware of their potential to cause a persistent base deficit.

  • base deficit
  • 0.9% saline
  • resuscitation
  • hyperchloraemic metabolic acidosis

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