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Hyperchloremia

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IN THIS ARTICLE:

What is Hyperchloremia?
Chloride facts
Hyperchloremia Predisposing factors
Hyperchloremia Causes
Hyperchloremia Symptoms
Hyperchloremia Diagnosis
Things to do when diagnosed with Hyperchloremia
Hyperchloremia Treatment
Sodium bicarbonate I.V infusion
Lactated Ringers solution
Low sodium diet
When to call your doctor?
Hyperchloremia Prevention

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.

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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
Kussmauls 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:-

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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

Know The Symptoms


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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 Ringers 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 doctors 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

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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

Kidney Failure Symptoms


Sodium Levels in the Body
Symptoms and Causes
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