BACKGROUND: This systematic review discusses a clinical physiology aspect of chloride in fluid therapy. Crystalloid solutions are one of the most widely used remedies. While generally used in medicine for almost 190 years, studies focused largely on their safety have only been published since the new millennium. The most widely used solution, normal saline, is most often referred to in this context. Its excessive administration results in hyperchloremic metabolic acidosis with other consequences, including higher mortality rates. METHODS: Original papers and review articles eligible for developing the present paper were identified by searching online in the electronic MEDLINE database. The keywords searched for included hyperchloremia, hypochloremia, and compound words containing the word "chloride," infusion therapy, metabolic acidosis, renal failure, and review. RESULTS: A total of 21,758 papers published before 31 May 2020 were identified; of this number, 630 duplicates were removed from the list. Upon excluding articles based on their title or abstract, 1850 papers were screened, of which 63 full-text articles were assessed. CONCLUSIONS: According to the latest medical concepts, dyschloremia (both hyperchloremia and hypochloremia) represents a factor indisputably having a negative effect on selected variables of clinical outcome. As infusion therapy can significantly impact chloride homeostasis of the body, the choice of infusion solutions should always take into account the potentially adverse impact of chloride content on chloremia and organ function.

Center of Research and Development University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Anesthesia Pain Management and Perioperative Medicine Dalhousie University Halifax NS Canada

Department of Anesthesiology Perioperative and Intensive Care Medicine Faculty of Healthcare Studies J E Purkyne University in Usti nad Labem and Krajska zdravotni a s Masaryk Hospital in Usti nad Labem Usti nad Labem Czech Republic

Department of Anesthesiology Resuscitation and Intensive Care Medicine University Hospital Hradec Kralove Sokolská 581 500 05 Hradec Kralove Czech Republic

Department of Anesthesiology Resuscitation and Intensive Care Medicine University Hospital Plzen Plzen Czech Republic

Department of Urology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Faculty of Medicine in Hradec Kralove Charles University Prague Czech Republic

Faculty of Medicine in Plzen Charles University Plzen Czech Republic

Technical University in Liberec Liberec Czech Republic

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