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Derivative instruments (Locations and Effective Portions of Gain (Loss) Reclassified out of AOCI) (Details) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2017 | Sep. 30, 2017 | Jun. 30, 2017 | Mar. 31, 2017 | Dec. 31, 2018 | Dec. 31, 2017 | Dec. 31, 2016
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest and other income, net |  |  |  |  |  |  |  |  | $ 674 | $ 928 | $ 629
Interest expense, net |  |  |  |  |  |  |  |  | (1,392) | (1,304) | (1,260)
Income before income taxes |  |  |  |  |  |  |  |  | 9,545 | 9,597 | 9,163
Product sales [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales | $ 6,001 | $ 5,510 | $ 5,679 | $ 5,343 | $ 5,569 | $ 5,453 | $ 5,574 | $ 5,199 | 22,533 | 21,795 | 21,892
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Income before income taxes |  |  |  |  |  |  |  |  | (262) | 638 | (139)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Foreign currency contracts [Member] | Product sales [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales |  |  |  |  |  |  |  |  | (21) |  |
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cross-currency swap contracts [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest and other income, net |  |  |  |  |  |  |  |  | (241) |  |
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Income before income taxes |  |  |  |  |  |  |  |  | (262) | 638 | (139)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Foreign currency contracts [Member] | Product sales [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales |  |  |  |  |  |  |  |  | (21) | 65 | 308
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Cross-currency swap contracts [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest and other income, net |  |  |  |  |  |  |  |  | (241) | 574 | (446)
Accumulated net gain (loss) from cash flow hedges [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedge [Member] | Forward interest rate contracts [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative Instruments Gain Loss [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest expense, net |  |  |  |  |  |  |  |  | $ 0 | $ (1) | $ (1)

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