Dyschloremia in Critically Ill Children as a Risk Factor for an Unfavorable Disease Outcome

Background: Dyschloremia is a common electrolyte imbalance that exacerbates many critical conditions in children.

Objective: To analyze etiology and pathogenic mechanisms of dyschloremia, its impact on an outcome of pediatric critical conditions based on literature data.

Materials and methods: We searched for and analyzed publications in the Cochrane Library, PubMed, and Medscape using the following keywords: dyschloremia, hypochloremia, hyperchloremia, children, adolescents, intensive care, critical conditions. A total of 45 sources were selected for review. To be included in the review, a paper had to describe the etiology and impact of dyschloremia on the course of critical conditions in children and adolescents. The exclusion criterion was the information on the etiology and impact of dyschloremia on the disease course in seriously ill adults and older people.

Results: Dyschloremia is quite often discovered in seriously ill children and adolescents treated in intensive care units. Hypochloremia caused by a variety of etiological factors can increase mortality in patients with acute heart failure and acute kidney injury. Hyperchloremia, which develops from excessive saline infusion, hyperchloremic acidosis, and kidney failure, increases mortality in critically ill patients, primarily in cases of severe trauma and sepsis.

Conclusions: Disturbed chloride balance plays an important role in pediatric intensive care. The chloride levels should be closely monitored in critically ill children.

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