Iatrogenic hyperchloremia: An overview in hospitalized patients for pharmacists.

This article provides an overview of hyperchloremia, an electrolyte imbalance linked to increased risk of acute kidney injury (AKI) and metabolic acidosis, focusing on its pathophysiology and prevention strategies in hospitalized patients. It highlights that intravenous (IV) fluids, including resuscitation fluids, medication diluents, and total parenteral nutrition (TPN), contribute to chloride load, with unbalanced crystalloids like 0.9% sodium chloride associated with higher rates of hyperchloremia compared to balanced crystalloids such as lactated Ringer's or Plasma-Lyte. While multiple randomized controlled trials (RCTs) have not shown mortality differences between balanced and unbalanced fluids in critically ill patients, some evidence suggests patients with sepsis may benefit from balanced crystalloids to reduce AKI and mortality risk. The article also discusses the role of medication diluents and TPN as modifiable sources of chloride and emphasizes that management of hyperchloremia is primarily preventative, with further research needed on treatment approaches and specific patient populations.