Chloride imbalance
Hypochloremia and hyperchloremia are, respectively, conditions of deficient or excessive serum levels of the anion chloride. A predominantly extracellular anion, chloride accounts for two-thirds of all serum anions.
Secreted by stomach mucosa as hydrochloric acid, chloride provides an acid medium conducive to digestion and activation of enzymes. It also participates in maintaining acid-base and body water balances, influences the osmolality or tonicity of extracellular fluid, plays a role in the exchange of oxygen and carbon dioxide in red blood cells, and helps activate salivary amylase (which, in turn, activates the digestive process).
Causes
Chloride imbalance can stem from various causes.
Hypochloremia
Insufficient serum chloride levels can result from decreased chloride intake or absorption, as in low dietary sodium intake, sodium deficiency, potassium deficiency, and metabolic alkalosis. Administration of dextrose I.V. without electrolytes can also interfere with chloride absorption.
Excessive chloride loss can result from prolonged diarrhea or diaphoresis as well as loss of hydrochloric acid in gastric secretions from vomiting, gastric suctioning, or gastric surgery.
Hyperchloremia
Excessive chloride intake or absorption— as in hyperingestion of ammonium chloride or ureterointestinal anastomosis—can lead to hyperchloremia by allowing reabsorption of chloride by the bowel.
Clinical TipExcessive chloride intake can also result from administering normal saline solution I.V. or by another route, such as orally or by nasogastric tube, saline enema, or irrigation.
Hemoconcentration from dehydration can also lead to excess serum chloride.
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
