Hypochloremia
Synonym(s): Hypochloraemia
Introduction
- Definition: serum chloride concentration < 117 mEq/L.
Normal ranges and abnormal values are dependent on equipment used and reference ranges established for that equipment. - Chloride constitutes two thirds of the anion in the plasma and other components of the extracellular fluid.
- Chloride is the major anion filtered by glomeruli and reabsorbed in the renal tubules.
- Chloride ions play a role in determining osmolality and acid base status.
Presenting signs
- None directly associated with hypochloremia.
- Depend on the underlying causes.
Acute presentation
- Depends on the underlying causes.
Special risks
- Not reported associated with pure hypochloremia.
- Risks can be associated with hypocalcemia and hypokalemia Hypokalemia secondary to metabolic alkalosis Acid base imbalance.
Pathogenesis
Pathophysiology
- Change in chloride concentration caused by:
- Loss of chloride ions.
- Change in water balance (increase in free water). This is typically associated with a change in sodium concentration (hyponatremia Hyponatremia).
- Chloride needs to be corrected for changes in sodium (changes in water balance):
[Cl] (corrected)= [Cl](measured) x [Na] (normal) / [Na] (measured) - Artifactual hypochloremia (low measured [Cl], with normal corrected [Cl] :
- Congestive heart failure Heart: congestive heart failure.
- Hypoadrenocorticism Hypoadrenocorticism.
- Third space loss (eg pleural, abdominal)
- Gastrointestinal.
- Corrected hypochloremia (this typically occurs with metabolic alkalosis).
- Pseudo hypochloremia:
- Lipemic or
- Hyperproteinemic sample (secondary to titrimetric methods).
- Excessive loss of chloride relative to sodium:
- Vomiting of stomach contents.
- Diuretic therapy ( thiazide and loop diuretics)
- Chronic respiratory acidois.
- Loss of plasma during exercise.
- Trichuris vulpis infection.
- Diabetic ketoacidosis Diabetic ketoacidosis.
- Hyperadenocorticism Hyperadrenocorticism.
- Therapy with solution containing high sodium concentration relative to chloride
- Administration of sodium bicarbonate Sodium bicarbonate (very rare) .
- High dose sodium penicillin Benzylpenicillin (very rare).
Diagnosis
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Treatment
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Prevention
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Biondo A W & de Morais H A (2008) Chloride a quick reference. Vet Clin Small Animal Practice 38 (3), 459-465 PubMed.
- Schaer M (1999) Disorders of serum potassium, sodium, magnesium and chloride. J Vet Emerg Crit Care 9 (4), 209-217 VetMedResource.
- de Morais H S A (1992) Chloride ion in small animal practice: the forgotten ion. J Vet Emerg Crit Care 2 (1), 11-24 VetMedResource.
Other sources of information
- Small Animal Critical Care Medicine (2008) Eds D C Silverstein and K Hopper. Saunders Elsevier, S Louis Missouri.
- Fluid, Electrolytes and Acid-base Disorders in Small Animal Practice (2006) Eds S P DiBartola, Saunders Elsevier , St Louis Missouri.
- The Veterinary ICU Book (2002) Eds W E Wingfield and M R Raffee. Teton New Media, Jackson Hole, WY.