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Hyperchloremia is an electrolyte disturbance in which there is an elevated level of chloride ions in the blood. [1] The normal serum range for chloride is 96 to 106 mEq/L, [2] therefore chloride levels at or above 110 mEq/L usually indicate kidney dysfunction as it is a regulator of chloride concentration. [3]
The normal blood reference range of chloride for adults in most labs is 96 to 106 milliequivalents (mEq) per liter. The normal range may vary slightly from lab to lab. Normal ranges are usually shown next to results in the lab report. A diagnostic test may use a chloridometer to determine the serum chloride level.
Chloride is part of gastric acid (HCl), which plays a role in absorption of electrolytes, activating enzymes, and killing bacteria. The levels of chloride in the blood can help determine if there are underlying metabolic disorders. [20] Generally, chloride has an inverse relationship with bicarbonate, an electrolyte that indicates acid-base ...
Diuretic therapy – loop diuretics and thiazides can both initially cause increase in chloride, but once stores are depleted, urine excretion will be below < 25 mEq/L. The loss of fluid from sodium excretion causes a contraction alkalosis. Diuretic abuse among athletes [4] and people with eating disorders [5] may present with metabolic alkalosis.
The pathophysiology of increased chloride concentration is the following: fluid secreted into the gut lumen contains higher amounts of Na + than Cl −; large losses of these fluids, particularly if volume is replaced with fluids containing equal amounts of Na + and Cl −, results in a decrease in the plasma Na + concentration relative to the ...
Diagnosis of contraction alkalosis is made by correlating laboratory data with clinical history and examination. Metabolic alkalosis in the presence of decreased effective circulatory volume, loop diuretic use, or other causes of intravascular depletion such as profound diarrhea should raise suspicion for contraction alkalosis as a likely etiology in the absence of other causes.
This is to maintain the plasma's electrical balance, as the chloride anions have been extracted. The bicarbonate content causes the venous blood leaving the stomach to be more alkaline than the arterial blood delivered to it. The alkaline tide is neutralised by a secretion of H + into the blood during HCO 3 − secretion in the pancreas. [2]
Still, the blood values are approximately equal between the arterial and venous sides for most substances, with the exception of acid–base, blood gases and drugs (used in therapeutic drug monitoring (TDM) assays). [6] Arterial levels for drugs are generally higher than venous levels because of extraction while passing through tissues. [6]