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Br J Anaesth. 2008 Aug;101(2):141-50. doi: 10.1093/bja/aen148. Epub 2008 Jun 4.

Physiological effects of hyperchloraemia and acidosis.

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Chelsea and Westminster NHS Foundation Trust, Imperial College London, 369 Fulham Road, London SW10 9NH, UK.


The advent of balanced solutions for i.v. fluid resuscitation and replacement is imminent and will affect any specialty involved in fluid management. Part of the background to their introduction has focused on the non-physiological nature of 'normal' saline solution and the developing science about the potential problems of hyperchloraemic acidosis. This review assesses the physiological significance of hyperchloraemic acidosis and of acidosis in general. It aims to differentiate the effects of the causes of acidosis from the physiological consequences of acidosis. It is intended to provide an assessment of the importance of hyperchloraemic acidosis and thereby the likely benefits of balanced solutions.

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