Hypochloremia (or Hypochloraemia) is an

electrolyte disturbance Electrolyte imbalance, or water-electrolyte imbalance, is an abnormality in the concentration of electrolytes in the body. Electrolytes play a vital role in maintaining homeostasis in the body. They help to regulate heart and neurological function ...

in which there is an abnormally low level of the

chloride The term chloride refers to a compound or molecule that contains either a chlorine anion (), which is a negatively charged chlorine atom, or a non-charged chlorine atom covalently bonded to the rest of the molecule by a single bond (). The pr ...

ion in the

blood Blood is a body fluid in the circulatory system of humans and other vertebrates that delivers necessary substances such as nutrients and oxygen to the cells, and transports metabolic waste products away from those same cells. Blood is com ...

. Normal serum range for chloride is 97 to 107 mmol/L with levels less than 96 mmol/L defining hypochloremia. Hypochloremia can contribute to

metabolic alkalosis Metabolic alkalosis is an acid-base disorder in which the pH of tissue is elevated beyond the normal range (7.35–7.45). This is the result of decreased hydrogen ion concentration, leading to increased bicarbonate (), or alternatively a dire ...

. Patients with mild hypochloremia may be asymptomatic. In significant chloride depletion and the resulting alkalosis, symptoms may include neuromuscular irritability, such as muscle cramps, twitching, and, in severe cases, seizures. Treatment involves diagnosing the underlying cause. Mild hypochloremia may be corrected by salt intake. For more severe hypochloremia, IV fluids may be given. It rarely occurs in the absence of other abnormalities. It is sometimes associated with

hypoventilation Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (''hypo'' meaning "below") to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide ( hypercap ...

. It can be associated with chronic

respiratory acidosis The respiratory system (also respiratory apparatus, ventilatory system) is a biological system consisting of specific organs and structures used for gas exchange in animals and plants. The anatomy and physiology that make this happen varies gr ...

. If it occurs together with

(decreased blood acidity) it is often due to

vomiting Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose. Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...

. It is usually the result of

hyponatremia Hyponatremia or hyponatraemia is a low concentration of sodium in the Serum (blood), blood. It is generally defined as a sodium concentration of less than 135 mmol/L (135 mEq/L), with severe hyponatremia being below 120 mEq/L. Symp ...

or elevated bicarbonate concentration. It occurs in cystic fibrosis.

Causes

Gastrointestinal causes

* Gastric fluid loss – loss of hydrochloric acid from the stomach due to severe

or nasogastric suction tube. * Congenital chloride diarrhea – rare autosomal recessive disease characterized by persistent, lifelong, watery diarrhea with high fecal chloride concentration.

Renal causes

* Diuretic therapy – Thiazide diuretics and loop diuretics like

furosemide Furosemide, sold under the brand name Lasix among others, is a loop diuretic medication used to treat edema due to heart failure, liver scarring, or kidney disease. Furosemide may also be used for the treatment of high blood pressure. It can ...

inhibit chloride reabsorption causing hypochloremia and metabolic alkalosis. Thiazides block NCC and furosemide blocks NKCC2. * Chronic respiratory acidosis – Compensatory reabsorption of bicarbonate in exchange for chloride. * Bartter syndrome – Chloride wasting due to defective NKCC2 Symptoms similar to loop diuretic therapy like furosemide. * Gitelman syndrome – Chloride wasting due to defective NCC. Symptoms similar to thiazide diuretic therapy.

Other causes

* Cystic fibrosis – Loss of chloride through excessive sweating due to defective chloride transport. * Excessive bicarbonate administration – Can dilute serum chloride and shift acid-base balance.

References

External links

Electrolyte disturbances {{Endocrine-disease-stub}