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Derivative instruments - Summary of Amount Recorded in Income & Expense (Details) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2023
Sep. 30, 2022
Sep. 30, 2023
Sep. 30, 2022
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales $ 6,903 $ 6,652 $ 19,994 $ 19,484
Other income (expense), net 685 100 2,431 (747)
Interest expense, net (759) (368) (2,054) (991)
Interest rate swap agreements        
Derivative Instruments, Gain (Loss) [Line Items]        
Gains (losses) on fair value hedging relationships, Hedged items 58 240 63 734
Gains (losses) on fair value hedging relationships, Derivatives designated as hedging instruments (37) (220) 5 (670)
Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Cross-currency swap contracts        
Derivative Instruments, Gain (Loss) [Line Items]        
Other income (expense), net (86) (198) (57) (461)
Product sales        
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales 6,548 6,237 19,077 18,249
Product sales | Reclassification out of Accumulated Other Comprehensive Income | Cash flow hedges | Foreign currency forward contracts        
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales $ 33 $ 69 $ 121 $ 149