Primary Outcome Measures:
- Mean base excess during hospital stay [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
Secondary Outcome Measures:
- Unmeasured anions (strong ion gap) and chloride levels during hospital stay [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
- Serum creatine levels [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
- Length of ICU stay [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
- Length of Emergency Department stay [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
- Length of hospital stay [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
- In-hospital mortality [ Time Frame: Six month control period (before) and 6 month intervention period (after) ] [ Designated as safety issue: No ]
This is a prospective, controlled, before-and-after study. The baseline pre-intervention period will include collection of data while doctors and nurses are unaware that such collection is taking place. During this time, high chloride fluids (saline, Gelofusine, 4% albumin) will continue to be used according to standard practice with an estimated 30,000 liters of saline as well as 2,000 bottles of Gelofusine® being consumed.
Following a wash out period of education and preparation, there will be a complete shift to a working environment where use of saline, Gelofusine and any other fluids with a high chloride level (>110 mmol/L)will be restricted and substituted with fluids of lower chloride concentration similar to blood; either Hartmann's solution or Plasmalyte® or 20% albumin.
The study will compare a 6 month control period (before) and a six month intervention period (after).