Ríos-Jaimes F, Vara-Salgado NA, Villarreal-Ríos E

Language: Spanish
References: 21
Page: 22-26
PDF size: 191.48 Kb.

ABSTRACT

Introduction. Shock is an entity that requires aggressive treatment, crystalloids are an option, however, they can cause adverse effects such as hyperchloremia, which has been associated with increased mortality.
Objective. To determine ΔCl- as a predictor of mortality in patients with shock treated with fluid resuscitation in the emergency department.
Material and methods. Retrospective cohort in records of patients with shock treated with crystalloids in the emergency room. Exposed group, ΔCl- of 4 or more mEq/L at 24 h, and unexposed group, ΔCl- less than 4 mEq/L at 24 h. ΔCl- was determined with the difference in serum Cl- at admission and at 24 h. The reason for discharge was identified as death or improvement. The analysis included the Mann-Whitney test, chi2, relative risk and confidence interval for relative risk.
Results. In septic shock, in the group with ΔCl- of 4 or more mEq/L at 24 h, mortality was 57.7% and in the group with ΔCl- less than 4 mEq/L at 24 h, mortality was 13.0%, ( chi2= 10.46, p= 0.001). For every 4.24 patients with ΔCl- of 4 or more mEq/L who die, there is one patient with ΔCl- less than 4 mEq/L who also dies (RR=4.24 (95% CI; 1.46-13.33)). ΔCl- was not identified as a predictor of mortality in nonhemorrhagic hypovolemic shock (chi2=0.56, p=0.453), nor in hemorrhagic hypovolemic shock (chi2=0.03, p=0.849).
Conclusion. ΔCl- is a predictor of mortality in septic shock, but not in hypovolemic shock.

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