MEDICAL SURGICAL NURSING: FLUIDS 1.10.

9 NURSE ANGIE 2018

Hyperchloremia
Excessive serum levels of the chloride anion

Normal Chloride Levels 97-107 mg/dL Assessment

Cardiac: Pitting edema, Dyspnea,
Rapid deep breathing,
Pathophysiology Tachypnea, Hypertension, Signs
of heart failure with pulmonary
Chloride accounts for two-thirds of all serum anions. Chloride is secreted by the stomach mucosa edema
Musculoskeletal: Weakness,
as hydrochloric acid; it provides an acid medium that aids digestion and activation of enzymes.
musculoskeletal difficulties
Chloride helps maintain acid-base and body water balances. An inverse relationship exists between Neuro: Agitation
chloride and bicarbonate. When the level of one goes up, the level of the other goes down.

Treatments
‣ Sodium bicarbonate I.V.
‣ I.V. fluid therapy with lactated
Ringer solution
‣ Loop diuretics to address fluid
overload
‣ Mineralocorticoids for aldosterone
deficiency and to prevent heart
failure 

Laboratory Findings: 


‣ Chloride level (serum) is greater than 108 mEq/L.

‣ With metabolic acidosis, arterial blood gas analysis shows pH is less than 7.35, carbon dioxide level is less than 22 mEq/
L, and the anion gap is normal.
‣ Sodium level (serum) is greater than 145 mEq/L.
Drugs that cause
Hyperchloremia
‣ acetaZOLAMIDE
‣ ammonium chloride
‣ sodium polystyrene sulfonate
INTERVENTIONS EDUCATION CAUSES
‣ salicylates
‣ Serum electrolyte levels, ‣ Avoid foods high in ‣ Hypernatremia
‣ chloride: tomato juice, ‣ triamterene
especially sodium, chloride, ‣ Hyperparathyroidism
‣ bananas, dates, eggs,
and potassium levels ‣ cheese, milk, salty broth, ‣ Loss of pancreatic
‣ Respiratory status ‣ canned veggies secretion
‣ Signs of metabolic alkalosis ‣ ‣ Avoid free water w/out ‣ Diabetes insipidus
‣ electrolytes if excreting
‣ Intake and output ‣ large amount of chloride ‣ Autoimmune disorders
‣ Daily weight ‣ (sweating) ‣ Metabolic acidosis
‣ Location and extent of edema ‣ Prolonged diarrhea
‣ Neurologic status ‣ Renal tubular acidosis
‣ Cardiopulmonary status,
including cardiac rhythm
‣ ABG levels
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 NCLEX PRACTICE NURSE ANGIE 2018

CASE STUDY
1. Explain the medical management of Hyperchloremia.

2. Explain the signs and symptoms of Hyperchloremia

ANSWERS AND EXPECTED FINDINGS

1. Correct underlying cause. Restore electrolyte imbalances. Hypotonic IV fluids (LR), IV sodium bicarb to increase levels so
as to excrete chloride (they compete for Na+ combination), diuretics to eliminate chloride. Sodium, chloride & fluids
restricted

2. Same as those of metabolic acidosis - hypervolemia & hypernatremia

Tachypnea, weakness, lethargy, deep, rapid respirations, diminished
cognitive ability, HTN, decreased cardiac output, dysrhythmias, and coma,
fluid retention High chloride accompanied by high Na+ and fluid retention

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