CHLORIDE

 CHLORIDE, THE MAJOR ANION OF THE ECF

 LOW CHLORIDE LEVELS PARALLEL LOW SODIUM LEVELS
 CHLORIDE IS NEGATIVELY CHARGES SODIUM IS POSITIVELY CHARGED
 CHLORIDE IS IMPORTANT IN MAINTAINING ACID-BASE IMBALACE BEC.
CHLORIDE AND BICARBONATE HAVE OPPOSITE RELATIONSHIP
 Chloride is produced in the stomach, where it combines with hydrogen
to form hydrochloric acid
 Normal serum chloride level 97 to 107 mEq/L (97 to 107 mmol/L)
 Inside the cell, the chloride level is 4 mEq/L
 Aldosterone secretion increases sodium reabsorption, thereby increasing
chloride reabsorption
Assessment and Diagnostic Findings
 In addition to the chloride level, sodium and potassium levels are also evaluated, because these
electrolytes are lost along with chloride. Arterial blood gas analysis identifies the acid–base imbalance,
which is usually metabolic alkalosis. The urine chloride level, which is also measured, decreases in
hypochloremia
CHLORIDE DEFICIT (HYPOCHLOREMIA)
Hypochloremia is a serum chloride level below 97
mEq/L (97 mmol/L).
Clinical Manifestations
 The signs and symptoms of hypochloremia are those of acid–base and electrolyte
imbalances. The signs and symptoms of hyponatremia, hypokalemia, and metabolic
alkalosis may also be present.
 Hyperexcitability of muscles,
 tetany,
 hyperactive DTRs,
 weakness,
 twitching,
 and muscle cramps may result
Medical Management
Treatment involves correcting the cause of hypochloremia and the contributing electrolyte and
acid–base imbalances. Normal saline (0.9% sodium chloride) or half-strength saline (0.45% sodium
chloride) solution is administered by IV to replace the chloride. If the patient is receiving a diuretic
(loop, osmotic, or thiazide), it may be discontinued or another diuretic prescribed.
Nursing Management

The nurse provides and teaches the patient about foods with high chloride content. Foods high
in chloride include tomato juice, bananas, dates, eggs, cheese, milk, salty broth, canned vegetables,
and processed meats.
CHLORIDE EXCESS (HYPERCHLOREMIA)

 Hyperchloremia
 serum level of chloride exceeds 107 mEq/L (107 mmol/L)
 Hypernatremia, bicarbonate loss, and metabolic acidosis can occur
with high chloride levels.
 Clinical Manifestations
 The signs and symptoms of hyperchloremia are the same as those of metabolic acidosis:
hypervolemia and hypernatremia.
 Tachypnea;
 weakness;
 lethargy;
 deep, rapid respirations;
 diminished cognitive ability;
 and hypertension occur.
 If untreated, hyperchloremia can lead to a decrease in cardiac output, dysrhythmias, and coma.
 Medical Management

 Correcting the underlying cause of hyperchloremia and restoring electrolyte,

fluid, and acid–base balance are essential. Hypotonic IV solutions may be
administered to restore balance.
 Nursing Management
 MONITOR
 VITAL SIGNS,
 ARTERIAL BLOOD GAS VALUES, AND
 I&O
 ASSESSMENT FINDINGS RELATED TO
 RESPIRATORY,
 NEUROLOGIC, AND
 CARDIAC SYSTEMS
 THE NURSE TEACHES THE PATIENT ABOUT THE DIET THAT SHOULD BE FOLLOWED TO MANAGE
HYPERCHLOREMIA AND MAINTAIN ADEQUATE HYDRATION