GROUP 8:

ALI, Hidjara M.
ANGDAO, Princess Saideh C.
PIMPING, Sittie Hafsa M.

HYPOCHLOREMIA

Hypochloremia is an electrolyte imbalance and is indicated by a low level of chloride

in the blood. This occurs when serum chloride levels fall below 96 mEq/L. The
normal adult value for chloride is 96-106 mEq/L.
Chloride in the blood is an important electrolyte and works to ensure that the
body’s metabolism is working correctly. It also helps the acid and base balance in
the body.

Pathophysiology

Hypochloremia can occur through this five main causes:

C - chloride loss from fluid loss through nausea or vomiting or by existing conditions,
diarrhea, diseases, severe diaphoresis, burns, or medications which results to dehydration.
H - hyponatremia. Hyponatremia is characterized by low sodium level. This is one of the
main causes of hypochloremia as chloride always follows sodium. If there's a low level in
sodium, and so with the chloride.
A - Addison's disease and adrenal crisis. Addison's disease, also called as adrenal
insufficiency, is an uncommon disease that occurs when the body does not make enough of
certain hormones. In Addison's the adrenal glands make too little aldosterone, a hormone
responsible for sodium and water regulation in the body by keeping sodium in and releasing
potassium from the body. A deficiency of aldosterone causes the body to excrete large
amounts of sodium and retain potassium, leading to low levels of sodium and high levels of
potassium in the blood. The person may experience diarrhea and vomiting.
M - medications. Primary renal chloride losses are due to the use of some diuretics such as
loop diuretics, thiazides, and acetazolamide which increase excretion of chloride as well as
sodium and potassium and person who experience this may feel dizziness, headache, and
dehydration.
P - pH imbalances from metabolic alkalosis. This is sodium and potassium deficiency that
affect acid-base or electrolyte balance, such as Addison’s disease. As I have mentioned
earlier, Addison's disease causes the adrenal glands to produce too little amount of
aldosterone which in turn releases more sodium and let the potassium retain in the body
which results to a pH imbalances particularly the metabolic alkalosis. Metabolic alkalosis is
an increase in bicarbonate in the blood that may occur due to kidney diseases. Chloride and
bicarbonate have an inverse relationship. When the level of one goes down, the level of the
other goes up which is why it results into metabolic alkalosis. The person may experience
fatigue, nausea, vomiting, and confusion.

Signs & Symptoms

1. fluid loss
2. dehydration
3. weakness or fatigue
4. difficulty breathing
5. diarrhea or vomiting, caused by fluid loss
Hypochloremia can also frequently accompany hyponatremia, a low amount of sodium
in the blood.

Diagnostic Tests

● Blood test to check your chloride level.

● Typically, blood chloride isn’t the only factor tested. It’ll be
included as part of a metabolic or electrolyte panel.
● An electrolyte panel is a blood test that measures chloride,
bicarbonate, potassium, and sodium.
● if the doctor suspects metabolic alkalosis, they may order a urine
chloride test and urine sodium test.
○ blood chloride test
○ urine chloride test
○ urine sodium test

Medical Management

✓ Treatment involves correcting the cause of hypochloremia and the contributing

electrolyte and acid–base imbalances.
✓ Normal saline (0.9% sodium chloride)
✓ Half-strength saline (0.45% sodium chloride) solution is given by IV to
replace the chloride
✓ Ammonium chloride, an acidifying IV agent, may be prescribed to treat
metabolic alkalosis

Nursing Management

✓ The nurse monitors the patient’s I&O, ABG values, and serum electrolyte levels.
✓ Changes in the patient’s level of consciousness and muscle strength and movement
are reported to the primary provider promptly.
✓ Vital signs are monitored, and respiratory assessment is carried out frequently.
✓ The nurse provides and educates the patient about foods with high chloride content.
✓ A person who drinks free water (water without electrolytes) or bottled water and
excretes large amounts of chloride needs instruction to avoid drinking this kind of water