Chloride Imbalance

What is Chloride Imbalance ?

Hypochloremia and hyperchloremia are chloride imbalances. A deficient serum level of the anion chloride results in hypochloremia; an excessive serum chloride level causes hyperchloremia. A predominantly extracellular anion, chloride accounts for two-thirds of all serum anions.

Chloride- secreted by the stomach mucosa as hydrochloric acid - 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 (ECF), plays a role in oxygen and carbon dioxide exchange in red blood cells, and helps activate salivaty amylase (which, in turn, activates the digestive process).

Causes of Chloride Imbalance

Hypochloremia may result from:

• decreased chloride intake or absorption, as in low dietary sodium intake, sodium deficiency, potassium deficiency, and metabolic alkalosis; prolonged use of mercurial diuretics; or administration of I.V. dextrose without electrolytes
• excessive chloride loss, resulting from prolonged diarrhea or diaphoresis; or loss of hydrochloric acid in gastric secretions due to vomiting, gastric suctioning, or gastric surgery.

Hyperchloremia may result from:

• excessive chloride intake or absorption (as in hyperingestion of ammonium chloride or ureteroin­testinal anastomosis) allowing reabsorption of chloride by the bowel
• hemoconcentration, caused by dehydration
• compensatory mechanisms for other metabolic abnormalities, as in metabolic acidosis, brain stem injury causing neurogenic hyperventilation, and hyperparathyroidism.

Signs & Symptoms of Chloride Imbalance

An electrolyte imbalance may lead to a number of symptoms that depend on which electrolyte is out of balance and whether the level is too high or too low. If you have altered potassium, magnesium, sodium or calcium levels, you may experience one or more of the following symptoms:

• Nervous system disorders
• Blood pressure changes
• Confusion
• Bone disorders
• Muscle spasm
• Weakness
• Loss of elasticity in the skin
• Dry mouth and mucous membranes

Diagnostic Tests

Serum chloride levels less than 98 mEq/L confirm hypochloremia; supportive values with metabolic alkalosis include a serum pH over 7.45 and serum carbon dioxide levels greater than 32 mEq/L.

Treatment

For patients with hypochloremia, the goal of treatment is to correct the condition that causes excessive chloride loss and to give an oral replacement such as salty broth.

When oral therapy isn't possible or when emergency measures are necessary, treatment may include I.V. administration of normal saline solution (if hypovolemia is present) or chloride-containing drugs, such as ammonium chloride to increase serum chloride levels, and potassium chloride for metabolic alkalosis.

For patients with severe hyperchloremic acidosis, treatment consists of sodium bicarbonate I.V. to raise serum bicarbonate levels and permit renal excretion of the chloride anion because bicarbonate and chloride compete for combination with sodium. For mild hyperchloremia, lactated Ringer's solution is administered; it converts to bicarbonate in the liver, thus increasing base bicarbonate to correct acidosis.

Prevention Tips

Some people consume adequate amounts of magnesium in the food they eat. Dietary supplements can be used safely, but should only be used under a doctor's supervision.