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Abstract

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

Abstract:  An infant was cleansed with 2% clorhexidine gluconate (CHG) because of repeated sepsis episodes from skin colonization. Asymptomatic hyperchloremia ensued, most likely associated with CHG therapy. Fourty-eight hours after CHG therapy withdrawal, serum chloride levels returned to normal. Hyperchloremia may be a reversible adverse effect of extensive use of CHG.

Chlorhexidine gluconate (CHG) is used for daily bathing, full-body skin cleansing, catheter-site skin preparation, umblical cord care, and Staphylococcus aureus decolonization (1). Here, we report a low-birth-weight infant who was cleansed using CHG because of repeated sepsis supposedly acquired through the skin and experienced hyperchloremia that was considered to be related to CHG treatment and resolved spontaneously after discontinuing CHG cleansing.

Case Report

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

A girl born at 29 weeks of gestation with a birth weight of 1,320 g had seven episodes of sepsis due to Staphylococcus aureus (3 episodes), Enterococcus faecium (2 episodes), Candida spp (1 episode), and Streptococcus sanguis (1 episode) by the age of 58 days. Because microbes were thought to enter the bloodstream through the skin, she had her whole body cleansed with 2% CHG (Dicideral Wash; Babgencel, Ankara, Turkey) for 2 weeks on alternate days after the last septicemic episode. At the end of the second week of CHG therapy, her temperature was 37.4°C, and she was hyperchloremic (125 mEq/L; normal range 98–107 mEq/L). Sepsis examination with interleukin-6 and C-reactive protein were negative, and renal function tests including blood urea nitrogen, creatinin, sodium, potasium, and blood pH levels were normal. Adverse skin reactions such as erythema, erosion, and burn were not observed. Possible causes of hyperchloremia such as sepsis, renal failure, acidosis or alkalosis, dehydration, drug therapy, and fluid intake were not found. CHG cleansing was stopped, and 48 hours later, chloride levels had normalized. She was discharged on day 70 with no sepsis recurrence.

Discussion

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References

Skin care practices for infants are controversial (2). Bathing may increase the risk of behavioral and physiologic instability and drug toxicity related to absorption of chemicals in premature infants (3). CHG has few adverse effects, including skin reactions such as erythema, erosion, and burn (1). Both 1% and 0.25% CHG for vaginal and neonatal cleansing to reduce neonatal sepsis and mortality have been found to be effective (3,4). Bacterial colonization was shown to be lower after 0.4% CHG bathing in full-term infants (4). One percent CHG in ethanol for umblical cord care is absorbed without toxicity in preterm infants with gestational ages between 31 and 36 5/7 weeks (1,290–2,790 g) (5). Two percent CHG does not accumulate in blood after daily repeated exposures such as bathing in children with a mean age of 6.8 years (range 3 mos to 17 yrs) (3).

Our patient developed hyperchloremia in the absence of other possible causes of high chloride levels such as metabolic acidosis, respiratory alkalosis, renal failure, dehydration, drugs such as carbonic anhydrate inhibitors, hyperparathyroidism, diarrhea, and external chloride intake such as intravenous fluids. Thus, the most likely origin of hyperchloremia was percutaneous absorption of CHG through the skin. Although CHG baths to reduce neonatal sepsis from cutaneous flora have been reported to be safe, symptomatic hyperchloremia should be kept in mind as a potential adverse effect, especially in infants with skin barrier immaturity.

References

  1. Top of page
  2. Abstract
  3. Case Report
  4. Discussion
  5. References