A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients

Madeline B Libin, Joel G Weltman, Jennifer Prittie Department of Emergency and Critical Care, Animal Medical Center, New York, NY, USACorrespondence: Madeline B LibinDepartment of Emergency and Critical Care, Animal Medical Center, 510 E. 62nd Street, New York, NY 10065, USATel +1 212 838 8100Fax +1...

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Autores principales:	Libin MB, Weltman JG, Prittie J
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2020
Materias:	acute kidney injury iv fluid electrolytes hyperchloremia volume-adjusted chloride load Veterinary medicine SF600-1100
Acceso en línea:	https://doaj.org/article/5be240101cf74c599ed3928c2ee8d4cf
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spelling	oai:doaj.org-article:5be240101cf74c599ed3928c2ee8d4cf2021-12-02T08:21:05ZA Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients2230-2034https://doaj.org/article/5be240101cf74c599ed3928c2ee8d4cf2020-07-01T00:00:00Zhttps://www.dovepress.com/a-preliminary-investigation-into-the-association-of-chloride-concentra-peer-reviewed-article-VMRRhttps://doaj.org/toc/2230-2034Madeline B Libin, Joel G Weltman, Jennifer Prittie Department of Emergency and Critical Care, Animal Medical Center, New York, NY, USACorrespondence: Madeline B LibinDepartment of Emergency and Critical Care, Animal Medical Center, 510 E. 62nd Street, New York, NY 10065, USATel +1 212 838 8100Fax +1 212 752 2592Email madelinelibin@gmail.comPurpose: To evaluate whole blood chloride concentration and hospital-acquired AKI in hospitalized canine patients. Secondary outcome measures included the volume-adjusted chloride load, in-hospital mortality and length of ICU stay.Patients and Methods: This is a prospective, observational study. Sixty dogs admitted to the ICU and receiving IV fluid therapy for > 24 hours from February 2018 to July 2019. Corrected chloride and creatinine concentrations were obtained twice daily. Total volume of IV fluid and total chloride load were recorded. Volume-adjusted chloride load (VACL) was calculated by dividing the chloride administered by the volume of fluid administered. Hospital-acquired AKI was defined as an increase in creatinine of ≥ 26.5 μmol/L (0.3 mg/dL) or 150% from baseline to maximum. Survival to hospital discharge or non-survival and ICU length of stay were also recorded.Results: Fifteen out of 60 patients developed hospital-acquired AKI. Maximum corrected chloride was significantly different in AKI group (median 122.3 mmol/L) vs non-AKI group (median 118.1 mmol/L; p=0.0002). Six out of 60 patients developed hyperchloremia. Hyperchloremic patients were significantly more likely to develop in-hospital AKI (p=0.03). Patients hospitalized ≥ 2 days had a significantly higher [Cl−]max compared to those with shorter ICU stay (121.8 ± 5.9 mmol/L vs 117.5 ± 4.3 mmol/L; p=0.002). Eight out of 60 patients were non-survivors. Maximum corrected chloride and creatinine concentrations were not significantly different between survivors and non-survivors. VACL was not significantly different between AKI or mortality groups.Conclusion: Maximum corrected chloride concentration was significantly higher in dogs with hospital-acquired AKI, even amongst dogs without hyperchloremia. Additionally, maximum corrected chloride concentrations were significantly higher in dogs hospitalized in the ICU longer compared to those hospitalized for fewer than two days. There was no significant difference in VACL in any of the outcome groups. Results from this study suggest alterations in chloride may be observed alongside the development of acute kidney injuries. Future studies in critically ill dogs are warranted.Keywords: acute kidney injury, IV fluid, electrolytes, hyperchloremia, volume-adjusted chloride loadLibin MBWeltman JGPrittie JDove Medical Pressarticleacute kidney injuryiv fluidelectrolyteshyperchloremiavolume-adjusted chloride loadVeterinary medicineSF600-1100ENVeterinary Medicine: Research and Reports, Vol Volume 11, Pp 57-69 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	acute kidney injury iv fluid electrolytes hyperchloremia volume-adjusted chloride load Veterinary medicine SF600-1100
spellingShingle	acute kidney injury iv fluid electrolytes hyperchloremia volume-adjusted chloride load Veterinary medicine SF600-1100 Libin MB Weltman JG Prittie J A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
description	Madeline B Libin, Joel G Weltman, Jennifer Prittie Department of Emergency and Critical Care, Animal Medical Center, New York, NY, USACorrespondence: Madeline B LibinDepartment of Emergency and Critical Care, Animal Medical Center, 510 E. 62nd Street, New York, NY 10065, USATel +1 212 838 8100Fax +1 212 752 2592Email madelinelibin@gmail.comPurpose: To evaluate whole blood chloride concentration and hospital-acquired AKI in hospitalized canine patients. Secondary outcome measures included the volume-adjusted chloride load, in-hospital mortality and length of ICU stay.Patients and Methods: This is a prospective, observational study. Sixty dogs admitted to the ICU and receiving IV fluid therapy for > 24 hours from February 2018 to July 2019. Corrected chloride and creatinine concentrations were obtained twice daily. Total volume of IV fluid and total chloride load were recorded. Volume-adjusted chloride load (VACL) was calculated by dividing the chloride administered by the volume of fluid administered. Hospital-acquired AKI was defined as an increase in creatinine of ≥ 26.5 μmol/L (0.3 mg/dL) or 150% from baseline to maximum. Survival to hospital discharge or non-survival and ICU length of stay were also recorded.Results: Fifteen out of 60 patients developed hospital-acquired AKI. Maximum corrected chloride was significantly different in AKI group (median 122.3 mmol/L) vs non-AKI group (median 118.1 mmol/L; p=0.0002). Six out of 60 patients developed hyperchloremia. Hyperchloremic patients were significantly more likely to develop in-hospital AKI (p=0.03). Patients hospitalized ≥ 2 days had a significantly higher [Cl−]max compared to those with shorter ICU stay (121.8 ± 5.9 mmol/L vs 117.5 ± 4.3 mmol/L; p=0.002). Eight out of 60 patients were non-survivors. Maximum corrected chloride and creatinine concentrations were not significantly different between survivors and non-survivors. VACL was not significantly different between AKI or mortality groups.Conclusion: Maximum corrected chloride concentration was significantly higher in dogs with hospital-acquired AKI, even amongst dogs without hyperchloremia. Additionally, maximum corrected chloride concentrations were significantly higher in dogs hospitalized in the ICU longer compared to those hospitalized for fewer than two days. There was no significant difference in VACL in any of the outcome groups. Results from this study suggest alterations in chloride may be observed alongside the development of acute kidney injuries. Future studies in critically ill dogs are warranted.Keywords: acute kidney injury, IV fluid, electrolytes, hyperchloremia, volume-adjusted chloride load
format	article
author	Libin MB Weltman JG Prittie J
author_facet	Libin MB Weltman JG Prittie J
author_sort	Libin MB
title	A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
title_short	A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
title_full	A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
title_fullStr	A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
title_full_unstemmed	A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients
title_sort	preliminary investigation into the association of chloride concentration on morbidity and mortality in hospitalized canine patients
publisher	Dove Medical Press
publishDate	2020
url	https://doaj.org/article/5be240101cf74c599ed3928c2ee8d4cf
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A Preliminary Investigation into the Association of Chloride Concentration on Morbidity and Mortality in Hospitalized Canine Patients

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