{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T18:49:26Z","timestamp":1784918966593,"version":"3.55.0"},"reference-count":107,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Life"],"abstract":"<jats:p>Chloride, the leading extracellular anion, plays a crucial role in acid-base balance, fluid homeostasis, and neuromuscular function. Despite historical underrecognition, emerging evidence demonstrates significant associations between chloremia disturbances and critical care outcomes. This paper aims to narratively review the pathophysiology, clinical features, and management strategies of chloremia disturbances in critically ill patients. Chloremia disturbances are common in ICU patients, with both hypochloremia (&lt;96 mEq\/L) and hyperchloremia (&gt;106 mEq\/L) independently associated with increased mortality, prolonged ICU length of stay, and organ dysfunction. In sepsis, chloride levels exhibit a prognostic value, with threshold effects around 105 mEq\/L. Hyperchloremia particularly increases acute kidney injury risk, while hypochloremia correlates with prolonged mechanical ventilation. The choice of resuscitation fluids significantly influences clinical outcomes, with balanced crystalloids potentially reducing adverse events if compared to normal saline solutions. Recent large-scale trials demonstrate lower rates of major adverse kidney events with chloride-restrictive strategies. Optimal management requires careful patient monitoring along with acid-base assessment. Treatment approaches must identify underlying causes to avoid complications. Prevention strategies include protocol-based fluid therapy, medication selection consideration, and early intervention in high-risk patients. Emerging technologies, including continuous monitoring systems and machine learning algorithms, offer promising advances for predicting and managing chloride disturbances.<\/jats:p>","DOI":"10.3390\/life16010151","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T13:27:53Z","timestamp":1768570073000},"page":"151","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Chloremia Disturbances in Critical Care: A Narrative Review of Pathophysiology, Clinical Impact and Management Strategies"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-0430-4682","authenticated-orcid":false,"given":"Nicola","family":"Sinatra","sequence":"first","affiliation":[{"name":"Nephrology and Dialysis Unit, \u201cPaolo Borsellino\u201d Hospital, Azienda Sanitaria Provinciale Trapani, 91025 Marsala, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-5271-1810","authenticated-orcid":false,"given":"Giuseppe","family":"Cuttone","sequence":"additional","affiliation":[{"name":"Anesthesia and Intensive Care, \u201cAbele Ajello\u201d Hospital, Azienda Sanitaria Provinciale Trapani, 91026 Mazara del Vallo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6159-8886","authenticated-orcid":false,"given":"Tarek Senussi","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of Cardiac Anesthesia and Intensive Care, Cardiovascular Network, IRCCS Policlinico San Martino Hospital, 16132 Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2156-7554","authenticated-orcid":false,"given":"Luigi La","family":"Via","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care 1, University Hospital Policlinico \u201cG. Rodolico\u2013San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca Maria","family":"Rubulotta","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Intensive Care 1, University Hospital Policlinico \u201cG. Rodolico\u2013San Marco\u201d, 95123 Catania, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurizio Giuseppe","family":"Abrignani","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cPaolo Borsellino\u201d Hospital, Azienda Sanitaria Provinciale Trapani, 91025 Marsala, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmelo","family":"Zumbino","sequence":"additional","affiliation":[{"name":"Department of Emergency, \u201cPaolo Giaccone\u201d University Hospital, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8500-8671","authenticated-orcid":false,"given":"Giuseppe","family":"Mul\u00e8","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, \u201cG. D\u2019Alessandro\u201d (PROMISE), University of Palermo, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3806-1151","authenticated-orcid":false,"given":"Giulio","family":"Geraci","sequence":"additional","affiliation":[{"name":"Faculty of Medicine and Surgery, Kore University, 94100 Enna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6767-8823","authenticated-orcid":false,"given":"Caterina","family":"Carollo","sequence":"additional","affiliation":[{"name":"Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties, \u201cG. D\u2019Alessandro\u201d (PROMISE), University of Palermo, 90100 Palermo, Italy"},{"name":"Unit of Nephrology and Hypertension, European Society of Hypertension Excellence Centre, University of Palermo, 90100 Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/j.ejim.2011.11.013","article-title":"Chloride: The queen of electrolytes?","volume":"23","author":"Berend","year":"2012","journal-title":"Eur. J. Intern. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/cc9052","article-title":"Bench-to-bedside review: Chloride in critical illness","volume":"14","author":"Yunos","year":"2010","journal-title":"Crit. 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