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Derivative instruments - Schedule of Income and Expense Line Items (Details) - USD ($)
$ in Millions
3 Months Ended 9 Months Ended
Sep. 30, 2025
Sep. 30, 2024
Sep. 30, 2025
Sep. 30, 2024
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales $ 9,557 $ 8,503 $ 26,885 $ 24,338
Other income, net 2,080 1,830 3,204 1,288
Interest expense, net (685) (776) (2,102) (2,408)
Cross-currency swap contracts | Reclassification out of AOCI | Cash flow hedges        
Derivative Instruments, Gain (Loss) [Line Items]        
Other income, net (39) 121 216 87
Interest rate swap agreements        
Derivative Instruments, Gain (Loss) [Line Items]        
(Losses) gains on fair value hedging relationships—interest rate swap agreements, hedged items (27) (153) (184) (122)
Derivatives designated as hedging instruments 40 168 227 176
Product sales        
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales 9,137 8,151 25,781 23,310
Product sales | Foreign currency forward contracts | Reclassification out of AOCI | Cash flow hedges        
Derivative Instruments, Gain (Loss) [Line Items]        
Product sales $ (28) $ 45 $ 40 $ 151