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Derivative instruments - (Summary of Income and Expense Line Items) (Details) - USD ($) $ in Millions | 3 Months Ended | 12 Months Ended
--- | --- | ---
Dec. 31, 2019 | Sep. 30, 2019 | Jun. 30, 2019 | Mar. 31, 2019 | Dec. 31, 2018 | Sep. 30, 2018 | Jun. 30, 2018 | Mar. 31, 2018 | Dec. 31, 2019 | Dec. 31, 2018 | Dec. 31, 2017
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales |  |  |  |  |  |  |  |  | $ 23,362 | $ 23,747 | $ 22,849
Interest and other income, net |  |  |  |  |  |  |  |  | 753 | 674 | 928
Interest expense, net |  |  |  |  |  |  |  |  | (1,289) | (1,392) | (1,304)
Interest rate swap agreements [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Gains (losses) on fair value hedging relationships, Hedged Items |  |  |  |  |  |  |  |  | (349) | 65 | 127
Gains (losses) on fair value hedging relationships, Derivatives designated as hedging instruments |  |  |  |  |  |  |  |  | 352 | (42) | (85)
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Cross-currency swap contracts [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest and other income, net |  |  |  |  |  |  |  |  | 110 | (241) | 574
Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Forward interest rate contract [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Interest expense, net |  |  |  |  |  |  |  |  |  |  | (1)
Product sales [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales | $ 5,881 | $ 5,463 | $ 5,574 | $ 5,286 | $ 6,001 | $ 5,510 | $ 5,679 | $ 5,343 | 22,204 | 22,533 | 21,795
Product sales [Member] | Reclassification out of Accumulated Other Comprehensive Income [Member] | Cash flow hedges [Member] | Foreign currency contracts [Member] |  |  |  |  |  |  |  |  |  |  |
Derivative [Line Items] |  |  |  |  |  |  |  |  |  |  |
Product sales |  |  |  |  |  |  |  |  | $ 101 | $ (21) | $ 65

X
- Definition Amount of gain (loss) from the increase (decrease) in fair value of derivative and nonderivative instruments designated as fair value hedging instruments recognized in the income statement. + References Reference 1: http://fasb.org/us-gaap/role/ref/legacyRef -Publisher FASB -Name Accounting Standards Codification -Topic 815 -SubTopic 25 -Section 50 -Paragraph 1 -Subparagraph (a)(1) -URI http://asc.fasb.org/extlink&oid=109977999&loc=d3e76258-113986 + Details
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