Hyperchloremia

What is Hyperchloremia?

Hyperchloremia is an electrolyte disturbance, where there is an abnormal elevation in the level of chloride ions in the blood stream. The normal range for chloride ion in serum is 97 to107 mEq/L. Thus, if this normal range is exceeded, it is called as Hyperchloremia. Also, Hyperchloremia may affect the transport of oxygen.

Chloride facts

• Chloride is the major anion seen in both, the blood and the extracellular fluid.
• According to The Vitamins and Nutrition Center, chloride, potassium and calcium are among the most important serum electrolytes.
• Anion is nothing, but the negatively charged portion of some substances like sodium chloride (NaCl) or table salt, on getting dissolved in liquid.
• Maximum of chloride ions we get by the food we eat. The normal values increase as we consume more of canned foods rich in salt.
• Helps in keeping the acid-base balance in the body.
• Sea water and human fluids has the same concentration of chloride ions.
• Chloride ion balance is regulated and maintained by the body. Any significant decrease or increase may have harmful or fatal consequences.
• During digestion, the intestines absorb the chloride.
• Excess chloride after the digestion process, gets excreted in the urine.
• Kidneys control the chloride levels in the blood.
• Abnormal elevation of chloride may be found in diarrhea, hyperparathyroidism and kidney diseases.

Hyperchloremia – Predisposing factors

Excessive infusion or ingestion of chloride ion (Cl-) containing compounds, such as, potassium chloride (KCl), Sodium chloride (NaCl), ammonium chloride, etc.

Hyperchloremia Causes

1. Artifact (low Anion Gap)

2. Metabolic and Endocrine

• High sodium level in blood
• Diabetes insipidus or diabetic coma
• Hyperparathyroidism
• Metabolic Acidosis
• Type I Renal Tubular Acidosis
• Type II Renal Tubular Acidosis (lightwood syndrome)
• Hypernatremia

3. Gastrointestinal

• Vomiting
• Prolonged Diarrhea
• Dehydration
• Kidney diseases
• Loss of pancreatic secretion
• Ureteral colonic anastomosis
• Ileal loops

4. Brain stem injury resulting in neurogenic hyperventilation

5. Medications

• Androgens
• Estrogens
• Corticosteroids
• Diuretics (carbonic anhydrase inhibitors)

Hyperchloremia Symptoms

Often, no symptoms are found.

Some include :-

• Excess fluid loss or dehydration (diarrhea, vomiting)
• High blood sugar
• Kussmaul’s breathing (deep and rapid breathing)
• Dyspnea
• Intense thirst
• Weakness
• Tachypnea
• Hypertension
• Pitting edema
• Diminished cognitive ability
• Possible coma

Hyperchloremia Diagnosis

• Serum chloride levels > 106 mEq/L confirm the diagnosis.
• Serum pH is under 7.35
• Serum carbon dioxide levels < 22 mEq/L.
• Sometimes, a chloride test can be done on a sample of the total urine collected over a 24-hour period (24-hour urine sample). This finds out how much chloride is excreted in the urine.

Things to do when diagnosed with Hyperchloremia

1. Inform your doctor
2. Do not take aspirin or aspirin containing products unless permitted
3. Inform your doctor if you have a history of diabetes, kidney, heart or liver diseases
4. Keep yourself hydrated by drinking 8 glasses of fluid every 24 hours.
5. Avoid alcohol and caffeine intake

Hyperchloremia Treatment

Just like other electrolyte imbalances, the treatment of high blood chloride levels or hyperchloremia is to correct the underlying cause. It includes the following causes:-

For dehydration

• Establish and maintain adequate hydration

For particular drug treatment

• Alter or discontinue the medications

For kidney disease

• Refer to a nephrologist

For hormone or endocrine causes

• Refer to an endocrinologist

Treatment

Sodium bicarbonate I.V infusion

This is to raise the bicarbonate level in blood and for permitting renal excretion of chloride anion, as chloride and bicarbonate compete to combine with sodium.

Lactated Ringer’s solution

This is administered in mind cases of hyperchloremia. In liver, this gets converted to bicarbonate, thereby increasing the base bicarbonate for correcting the acidosis caused.

Low sodium diet

The excess chloride ions may combine with sodium to form hypernatremia.

When to call your doctor?

• Extreme nausea that interferes with eating and not relieved by medicines
• Vomiting more than 4 to 5 times in a day
• Diarrhea – 4 to 6 episodes in a day, and not relieved by diet modification or anti-diarrhea drugs
• Severe constipation for 2 to 3 days, and not relieved by laxatives
• Irritability and muscle twitching
• Poor appetite and increased urination
• Excessive drowsiness or confusion

Hyperchloremia Prevention

1. Dietary supplementation of magnesium in their food; but, should be taken under the doctor’s supervision only.
2. The chloride present in the diet we consume is the most common source of the mineral and can help to keep the blood level of chloride within normal limits.
3. According to the National Institute of Health, adults should consume 2 to 2.3 g of chloride/day. This necessity decreases as the age advances, and increases during pregnancy and lactation.
4. Some foods such as include tomatoes and tomato juice, olives, celery, lettuce, etc. are high in chloride. So, this should be consumed in less quantity during elevated chloride ion levels.

References

http://en.wikipedia.org/wiki/Hyperchloremia

http://www.chemocare.com/managing/hyperchloremia-high-chloride.asp

http://www.fpnotebook.com/renal/Chloride/Hyprchlrm.htm

http://www.enurse-careplan.com/2010/07/nursing-care-plan-ncp-hyperchloremia.html

http://www.emedicinehealth.com/script/main/art.asp?articlekey=9999

http://www.family-health-information.com/diseases/metabolic-disorders/chloride-imbalance.htm

http://www.livestrong.com/article/270081-chloride-in-the-diet/#ixzz1o8PKgYln