الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 89 |  |  |
| | | from | 89 | | |
Abstract
Pediatric studies have demonstrated that hyperchloremia is associated with clinical outcomes including mortality. Hyperchloremia is known to cause a hyperchloremic metabolic acidosis. Furthermore, several studies demonstrated that hyperchloremic fluid administration leads to decreased renal blood flow and cortical tissue perfusion in healthy adults.
Several recent studies demonstrated that hyperchloremia is very common among critically ill patients and there is emerging evidence that it has an adverse impact on clinical outcome. Though the mechanism is unknown. To date, there is a lack of research to study neither the incidence of chloride disturbance on PICU admission nor the increase in serum chloride after the first day of admission in critically ill children.
Our aim in the current research was to detect the prevalence of hyperchloremia among critically ill children and to evaluate the association of the serum chloride level in admission or after the first 24 hours with the disease outcome.
This was a prospective observational study conducted at the Pediatric Intensive Care Unit (PICU) of Menoufia university hospital. The patient group included 150 critically ill children.
Full history was taken from patients including, personal history, and complaint, history of present illness, past history of diseases, operations or medication, family history, dietetic and vaccination history.
Thorough clinical examination included: general and local examination with emphasis on vital signs. Severity of illness in the first 24 hours was assessed by using. PRISM, PIM2, and pediatric SOFA score, laboratory investigations included: CBC, CRP, blood glucose, serum electrolytes, blood gas analysis, Blood Culture. Radiologic investigation when indicated. Chloride was measured within 2hours of PICU admission and 24hours later.
The primary outcome was PICU mortality. Secondary outcomes include length of PICU stay, the need for mechanical ventilation and mechanical ventilation duration.
In the current study, it was observed that the median admission chloride level was higher among non-survivors compared with survivors but the difference was not significant. Similarly, no significant difference was found between survivors and non-survivors regarding 24-hr chloride level. No significant difference in the frequency of hyperchloremia on admission and at 24-hours was detected between survivors and non-survivors.
No significant difference in the frequency of sepsis, acute respiratory distress syndrome (ARDS), mechanical ventilation, or mortality was found between patients with normal, low, or high chloride levels on admission. No significant difference was found between the 3 groups regarding the length of PICU stay or mechanical ventilation duration.
Summary
64
Non-survivors had a significantly higher PRISM, PIM2 and pSOFA as well as a significantly higher frequency of severe sepsis, acute respiratory distress syndrome (ARDS), mechanical ventilation rate, and longer mechanical ventilation duration.
In the current study, admission chloride and 24-hr levels had a significant weak negative correlations with WBC and base excess and hr chloride level had a significant weak positive correlation with-24 C and base excess
Univariate logistic regression analysis showed that pSOFA, mechanical ventilation, sepsis, and severe sepsis were positively associated with mortality. In multivariate analysis, however, only mechanical ventilation was the independent predictor of mortality.