Hyperchloremic acidosis is a form of
metabolic acidosis
Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidne ...
associated with a normal
anion gap
The anion gap (AG or AGAP) is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an electrolyte panel, which is often performed as part of a comprehensive metabolic panel.
The ...
, a decrease in plasma
bicarbonate
In inorganic chemistry, bicarbonate ( IUPAC-recommended nomenclature: hydrogencarbonate) is an intermediate form in the deprotonation of carbonic acid. It is a polyatomic anion with the chemical formula .
Bicarbonate serves a crucial bioch ...
concentration, and an increase in plasma
chloride
The chloride ion is the anion (negatively charged ion) Cl−. It is formed when the element chlorine (a halogen) gains an electron or when a compound such as hydrogen chloride is dissolved in water or other polar solvents. Chloride s ...
concentration
(see
anion gap
The anion gap (AG or AGAP) is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an electrolyte panel, which is often performed as part of a comprehensive metabolic panel.
The ...
for a fuller explanation). Although plasma anion gap is normal, this condition is often associated with an ''increased''
urine anion gap, due to the kidney's inability to secrete
ammonia
Ammonia is an inorganic compound of nitrogen and hydrogen with the formula . A stable binary hydride, and the simplest pnictogen hydride, ammonia is a colourless gas with a distinct pungent smell. Biologically, it is a common nitrogeno ...
.
Causes
In general, the cause of a hyperchloremic metabolic acidosis is a ''loss of base'', either a gastrointestinal loss or a renal loss.
*
Gastrointestinal
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The GI tract contains all the major organs of the digestive system, in humans and ...
loss of bicarbonate ()
** Severe
diarrhea
Diarrhea, also spelled diarrhoea, is the condition of having at least three loose, liquid, or watery bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss. Signs of dehydration often begin ...
(vomiting will tend to cause hypochloraemic
alkalosis
Alkalosis is the result of a process reducing hydrogen ion concentration of arterial blood plasma (alkalemia). In contrast to acidemia (serum pH 7.35 or lower), alkalemia occurs when the serum pH is higher than normal (7.45 or higher). Alkalosis ...
)
**
Pancreatic fistula
A pancreatic fistula is an abnormal communication between the pancreas and other organs due to leakage of pancreatic secretions from damaged pancreatic ducts. An ''external'' pancreatic fistula is one that communicates with the skin, and is also kn ...
with loss of bicarbonate rich pancreatic fluid
** Nasojejunal tube losses in the context of small bowel obstruction and loss of alkaline proximal small bowel secretions
** Chronic laxative abuse
*Renal causes
** Proximal
renal tubular acidosis
Renal tubular acidosis (RTA) is a medical condition that involves an accumulation of acid in the body due to a failure of the kidneys to appropriately acidify the urine. In renal physiology, when blood is filtered by the kidney, the filtrate p ...
with failure of resorption
** Distal renal tubular acidosis with failure of secretion
** Long-term use of a
carbonic anhydrase inhibitor
Carbonic anhydrase inhibitors are a class of pharmaceuticals that suppress the activity of carbonic anhydrase. Their clinical use has been established as anti-glaucoma agents, diuretics, antiepileptics, in the management of mountain sickness, g ...
such as
acetazolamide
Acetazolamide, sold under the trade name Diamox among others, is a medication used to treat glaucoma, epilepsy, altitude sickness, periodic paralysis, idiopathic intracranial hypertension (raised brain pressure of unclear cause), urine alka ...
*Other causes
** Ingestion of
ammonium chloride,
hydrochloric acid
Hydrochloric acid, also known as muriatic acid, is an aqueous solution of hydrogen chloride. It is a colorless solution with a distinctive pungent smell. It is classified as a strong acid. It is a component of the gastric acid in the dig ...
, or other acidifying salts
** The treatment and recovery phases of
diabetic ketoacidosis
Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of diabetes mellitus. Signs and symptoms may include vomiting, abdominal pain, deep gasping breathing, increased urination, weakness, confusion and occasionally los ...
**
Volume resuscitation with 0.9% normal saline provides a chloride load, so that infusing more than 3-4L can cause acidosis
**
Hyperalimentation
Overnutrition (also known as hyperalimentation) is a form of malnutrition in which the intake of nutrients is oversupplied. The amount of nutrients exceeds the amount required for normal growth, development, and metabolism.
The term can also ref ...
(''i.e.'',
total parenteral nutrition
Parenteral nutrition (PN) is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding companies. The person receives a nutritional m ...
)
See also
*
Anion gap
The anion gap (AG or AGAP) is a value calculated from the results of multiple individual medical lab tests. It may be reported with the results of an electrolyte panel, which is often performed as part of a comprehensive metabolic panel.
The ...
*
Metabolic acidosis
Metabolic acidosis is a serious electrolyte disorder characterized by an imbalance in the body's acid-base balance. Metabolic acidosis has three main root causes: increased acid production, loss of bicarbonate, and a reduced ability of the kidne ...
*
Pseudohypoaldosteronism
Pseudohypoaldosteronism (PHA) is a condition that mimics hypoaldosteronism. However, the condition is due to a failure of ''response'' to aldosterone, and levels of aldosterone are actually elevated, due to a lack of feedback inhibition.
Types
P ...
References
Further reading
*
External links
*
NIH - Renal Tubular Acidosis
{{DEFAULTSORT:Hyperchloremic Acidosis
Acid–base disturbances
Electrolyte disturbances