Hypochloremia: Difference between revisions

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Latest revision as of 21:20, 10 January 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief:Aditya Govindavarjhulla, M.B.B.S. [2]

Synonyms and keywords: Hypochloraemia

Overview

Hypochloremia is an electrolyte disturbance whereby there is an abnormally depleted level of the chloride ion in the blood. It rarely occurs in the absence of other abnormalities. If it occurs together with metabolic alkalosis (decreased blood acidity) it is often due to vomiting. Chloride is a primary anion of the extracellular fluid compartment and aids in maintenance of acid-base balance.

It can be associated with hypoventilation.^[1]

It can be associated with chronic respiratory acidosis.^[2]

Causes

Common Causes

Causes by Organ System

Cardiovascular	Congestive heart failure
Chemical / poisoning	No underlying causes
Dermatologic	Excessive sweating
Drug Side Effect	Aldosterone, Antacid abuse, Bendrofluazide, Corticosteroids, Corticotropin, Frusemide, Hydrochlorothiazide, Hyperaldosteronism, Laxatives, Loop diuretics, Metolazone, Thiazide diuretics, Triamterene
Ear Nose Throat	No underlying causes
Endocrine	Acth-secreting tumors, Adrenal cortex insufficiency, Bartter's syndrome, Cushing's syndrome, Excessive saline infusion, Excessive sweating, Pseudohyponatremia
Environmental	No underlying causes
Gastroenterologic	Antacid abuse, Bulimia nervosa, Diarrhea, Gastric suction, Gastrocolic fistula, Gastroesophageal reflux disease, Nausea and vomiting, Pyloric stenosis, Villous adenoma, Vomiting
Genetic	Acute intermittent porphyria
Hematologic	Acute intermittent porphyria, Adrenal cortex insufficiency, Anion gap high metabolic acidosis, Citrated blood sample, Massive blood transfusion, Milk alkali syndrome
Iatrogenic	Excessive saline infusion, Massive blood transfusion, Gastric suction
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	Diabetic coma, Syndrome of inappropriate antidiuretic hormone secretion (siadh)
Nutritional / Metabolic	Diabetic coma, Low sodium diet, Metabolic alkalosis, Overconsumption of licorice
Obstetric/Gynecologic	No underlying causes
Oncologic	Acth-secreting tumors, Villous adenoma
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Bulimia nervosa
Pulmonary	Gastroesophageal reflux disease, Hypoventilation, Respiratory acidosis, Respiratory losses
Renal / Electrolyte	Anion gap high metabolic acidosis, Bartter's syndrome, Excessive saline infusion, Hyperhidrosis, Hyponatremia, Low sodium diet, Metabolic alkalosis, Pseudohyponatremia, Renal failure, Salt losing nephropathy, Syndrome of inappropriate antidiuretic hormone secretion (siadh), Water overload
Rheum / Immune / Allergy	Cushing's syndrome, Cystic fibrosis
Sexual	No underlying causes
Trauma	Burns, Vomiting
Urologic	Renal failure
Miscellaneous	No underlying causes

Causes in Alphabetical Order ^[3] ^[4]

Diagnosis

Laboratory Findings

Normal values of Chloride are 99-111 mEq/L (99-111 mmol/L).

References

↑ Lavie CJ, Crocker EF, Key KJ, Ferguson TG (1986). "Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation". South. Med. J. 79 (10): 1296–9. doi:10.1097/00007611-198610000-00025. PMID 3764530. Unknown parameter |month= ignored (help)
↑ LEVITIN H, BRANSCOME W, EPSTEIN FH (1958). "The pathogenesis of hypochloremia in respiratory acidosis". J. Clin. Invest. 37 (12): 1667–75. doi:10.1172/JCI103758. PMC 1062852. PMID 13611033. Unknown parameter |month= ignored (help)
↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

Template:Fluid, electrolyte, acid base metabolic pathology Template:Endocrine, nutritional and metabolic pathology

Template:WikiDoc Sources

[pmid3764530-1] Lavie CJ, Crocker EF, Key KJ, Ferguson TG (1986). "Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation". South. Med. J. 79 (10): 1296–9. doi:10.1097/00007611-198610000-00025. PMID 3764530. Unknown parameter |month= ignored (help)

[pmid13611033-2] LEVITIN H, BRANSCOME W, EPSTEIN FH (1958). "The pathogenesis of hypochloremia in respiratory acidosis". J. Clin. Invest. 37 (12): 1667–75. doi:10.1172/JCI103758. PMC 1062852. PMID 13611033. Unknown parameter |month= ignored (help)

[3] Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016

[4] Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X

[1]

[2]

[3]

[4]

v t e Health Science · Medicine · Medical specialities · Intensive care medicine / Critical care medicine and Critical care nursing
General terms	Intensive care unit (ICU) · Neonatal intensive care unit (NICU) · Pediatric intensive care unit (PICU) · Coronary care unit (CCU) · Critical illness insurance
Conditions	Template:Navbox subgroup
Diagnosis	Arterial blood gas · Arterial catheter · Blood cultures · Central venous catheter · Pulmonary artery catheter · Screening cultures
Life supporting treatments	Airway management · Chest tube · Dialysis · Enteral feeding · Goal-directed therapy · Induced coma · Mechanical ventilation · Therapeutic hypothermia · Total parenteral nutrition
Drugs	Analgesics · Antibiotics · Antithrombotics · Inotropes · Intravenous fluids · Neuromuscular-blocking drugs · Recombinant activated protein C · Sedatives · Stress ulcer prevention drugs · Vasopressors
ICU scoring systems	APACHE II · Glasgow Coma Scale · PIM2 · SAPS II · SAPS III · SOFA
Organisations	Society of Critical Care Medicine · Surviving Sepsis Campaign
Related specialties	Anesthesia · Cardiology · Internal medicine · Neurology · Pediatrics · Pulmonology · Surgery · Traumatology

@@ Line 1: / Line 1: @@
-{{DiseaseDisorder infobox |
+__NOTOC__
-  Name        = {{PAGENAME}} |
-  ICD10       = {{ICD10|E|87|8|e|70}} |
-  ICD9        = {{ICD9|276.9}} |
-}}
 {{SI}}
-{{CMG}}
+{{CMG}}; {{AOEIC}}{{ADI}}
-{{Editor Help}}
+{{SK}} Hypochloraemia
 ==Overview==
-'''Hypochloremia''' (or '''Hypochloraemia''') is an [[electrolyte disturbance]] whereby there is an abnormally depleted level of the [[chloride]] ion in the [[blood]]. It rarely occurs in the absence of other abnormalities. If it occurs together with [[Alkalosis|metabolic alkalosis]] (decreased blood acidity) it is often due to [[vomiting]].
+Hypochloremia is an [[electrolyte disturbance]] whereby there is an abnormally depleted level of the [[chloride]] ion in the [[blood]]. It rarely occurs in the absence of other abnormalities. If it occurs together with [[Alkalosis|metabolic alkalosis]] (decreased blood acidity) it is often due to [[vomiting]].  Chloride is a primary anion of the [[extracellular fluid]] compartment and aids in maintenance of acid-base balance.
-'''Normal values of Chloride:''' 99-111 mEq/L (99-111 mmol/L)
-Primary anion of [[extracellular fluid]] compartment; aids in maintenance of acid-base balance.
-== Causes==
+It can be associated with [[hypoventilation]].<ref name="pmid3764530">{{cite journal |author=Lavie CJ, Crocker EF, Key KJ, Ferguson TG |title=Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation |journal=South. Med. J. |volume=79 |issue=10 |pages=1296–9 |year=1986 |month=October |pmid=3764530 |doi= 10.1097/00007611-198610000-00025|url=http://meta.wkhealth.com/pt/pt-core/template-journal/lwwgateway/media/landingpage.htm?issn=0038-4348&volume=79&issue=10&spage=1296}}</ref>
-===Complete Differential Diagnosis of the Causes of Hypochloremia===
+It can be associated with chronic [[respiratory acidosis]].<ref name="pmid13611033">{{cite journal |author=LEVITIN H, BRANSCOME W, EPSTEIN FH |title=The pathogenesis of hypochloremia in respiratory acidosis |journal=J. Clin. Invest. |volume=37 |issue=12 |pages=1667–75 |year=1958 |month=December |pmid=13611033 |pmc=1062852 |doi=10.1172/JCI103758}}</ref>
-In alphabetical order <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>  <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>
-* [[ACTH]]-secreting tumors
+==Causes==
-* [[Adrenal insufficiency]]
+===Common Causes===
-* [[Bulimia nervosa]]
+*[[Diarrhea]]
-* [[Burns]]
+*[[Vomiting]]
-* [[Congestive heart failure]]
+*[[Gastric suction]]
-* [[Cushing's syndrome]]
+*[[Renal failure]]
-* [[Diabetic]] [[coma]]
+*[[Burns]]
-* [[Diarrhea]]
+*[[Excessive sweating]]
-* [[Drugs]]
-* [[Excessive sweating]]
-* Gastric suction
-* [[Hyperaldosteronism]]
-* [[Hyponatremia]]
-* Overconsumption of [[licorice]]
-* Pseudohyponatremia
-* [[Renal failure]]
-* Respiratory losses
-* Salt-losing [[nephritis]]
-* [[Syndrome of inappropriate antidiuretic hormone secretion]] ([[SIADH]])
-* [[Vomiting]]
-===Complete Differential Diagnosis of the Causes of Hypochloremia===
+===Causes by Organ System===
-(By organ system)
 {|style="width:70%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
@@ Line 50: / Line 28: @@
 |-bgcolor="LightSteelBlue"
 | '''Chemical / poisoning'''
-|bgcolor="Beige"| [[Drugs]]
+|bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 58: / Line 36: @@
 |-bgcolor="LightSteelBlue"
 | '''Drug Side Effect'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Aldosterone]],  [[Antacid abuse]],  [[Bendrofluazide]],  [[Corticosteroids]],  [[Corticotropin]],  [[Frusemide]],  [[Hydrochlorothiazide]],  [[Hyperaldosteronism]],  [[Laxatives]],  [[Loop diuretics]],  [[Metolazone]],  [[Thiazide diuretics]],  [[Triamterene]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 66: / Line 44: @@
 |-bgcolor="LightSteelBlue"
 | '''Endocrine'''
-|bgcolor="Beige"| [[ACTH]]-secreting tumors, [[Adrenal insufficiency]], [[Cushing's syndrome]], [[Diabetic]] [[coma]], [[Hyperaldosteronism]], [[Hyponatremia]], Pseudohyponatremia, [[Syndrome of inappropriate antidiuretic hormone secretion]] ([[SIADH]])
+|bgcolor="Beige"| [[Acth-secreting tumors]],  [[Adrenal cortex insufficiency]],  [[Bartter's syndrome]],  [[Cushing's syndrome]],  [[Excessive saline infusion]],  [[Excessive sweating]],  [[Pseudohyponatremia]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 74: / Line 52: @@
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| [[Bulimia nervosa]], [[Diarrhea]], Gastric suction, [[Vomiting]]
+|bgcolor="Beige"| [[Antacid abuse]],  [[Bulimia nervosa]],  [[Diarrhea]],  [[Gastric suction]],  [[Gastrocolic fistula]],  [[Gastroesophageal reflux disease]],  [[Nausea and vomiting]],  [[Pyloric stenosis]],  [[Villous adenoma]],  [[Vomiting]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Genetic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute intermittent porphyria]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Hematologic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Acute intermittent porphyria]],  [[Adrenal cortex insufficiency]],  [[Anion gap high metabolic acidosis]],  [[Citrated blood sample]],  [[Massive blood transfusion]],  [[Milk alkali syndrome]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Iatrogenic'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Excessive saline infusion]], [[Massive blood transfusion]], [[Gastric suction]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 98: / Line 76: @@
 |-bgcolor="LightSteelBlue"
 | '''Neurologic'''
-|bgcolor="Beige"| [[Excessive sweating]]
+|bgcolor="Beige"| [[Diabetic coma]],  [[Syndrome of inappropriate antidiuretic hormone secretion (siadh)]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Nutritional / Metabolic'''
-|bgcolor="Beige"| Overconsumption of [[licorice]]
+|bgcolor="Beige"| [[Diabetic coma]],  [[Low sodium diet]],  [[Metabolic alkalosis]],  [[Overconsumption of licorice]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 110: / Line 88: @@
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| [[ACTH]]-secreting tumors
+|bgcolor="Beige"| [[Acth-secreting tumors]],  [[Villous adenoma]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 118: / Line 96: @@
 |-bgcolor="LightSteelBlue"
 | '''Overdose / Toxicity'''
-|bgcolor="Beige"| [[Drugs]]
+|bgcolor="Beige"| No underlying causes
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 126: / Line 104: @@
 |-bgcolor="LightSteelBlue"
 | '''Pulmonary'''
-|bgcolor="Beige"| Respiratory losses
+|bgcolor="Beige"| [[Gastroesophageal reflux disease]],  [[Hypoventilation]],  [[Respiratory acidosis]],  [[Respiratory losses]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Renal / Electrolyte'''
-|bgcolor="Beige"| [[Hyponatremia]], [[Renal failure]], Salt-losing [[nephritis]]
+|bgcolor="Beige"| [[Anion gap high metabolic acidosis]],  [[Bartter's syndrome]],  [[Excessive saline infusion]],  [[Hyperhidrosis]],  [[Hyponatremia]],  [[Low sodium diet]],  [[Metabolic alkalosis]],  [[Pseudohyponatremia]],  [[Renal failure]],  [[Salt losing nephropathy]],  [[Syndrome of inappropriate antidiuretic hormone secretion (siadh)]],  [[Water overload]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Rheum / Immune / Allergy'''
-|bgcolor="Beige"| No underlying causes
+|bgcolor="Beige"| [[Cushing's syndrome]],  [[Cystic fibrosis]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 142: / Line 120: @@
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| [[Burns]]
+|bgcolor="Beige"| [[Burns]],  [[Vomiting]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 153: / Line 131: @@
 |-
 |}
+===Causes in Alphabetical Order <ref>Sailer, Christian, Wasner, Susanne.  Differential Diagnosis Pocket.  Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016</ref>  <ref>Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X</ref>===
+{{columns-list|
+*[[Acth-secreting tumors]]
+*[[Acute intermittent porphyria]]
+*[[Adrenal cortex insufficiency]]
+*[[Aldosterone]]
+*[[Anion gap high metabolic acidosis]]
+*[[Antacid abuse]]
+*[[Bartter's syndrome]]
+*[[Bendrofluazide]]
+*[[Bulimia nervosa]]
+*[[Burns]]
+*[[Citrated blood sample]]
+*[[Congestive heart failure]]
+*[[Corticosteroids]]
+*[[Corticotropin]]
+*[[Cushing's syndrome]]
+*[[Cystic fibrosis]]
+*[[Diabetic coma]]
+*[[Diarrhea]]
+*[[Excessive saline infusion]]
+*[[Excessive sweating]]
+*[[Frusemide]]
+*[[Gastric suction]]
+*[[Gastrocolic fistula]]
+*[[Gastroesophageal reflux disease]]
+*[[Hydrochlorothiazide]]
+*[[Hyperaldosteronism]]
+*[[Hyperhidrosis]]
+*[[Hyponatremia]]
+*[[Hypoventilation]]
+*[[Laxatives]]
+*[[Loop diuretics]]
+*[[Low sodium diet]]
+*[[Massive blood transfusion]]
+*[[Metabolic alkalosis]]
+*[[Metolazone]]
+*[[Milk alkali syndrome]]
+*[[Nausea and vomiting]]
+*[[Overconsumption of licorice]]
+*[[Pseudohyponatremia]]
+*[[Pyloric stenosis]]
+*[[Renal failure]]
+*[[Respiratory acidosis]]
+*[[Respiratory losses]]
+*[[Salt losing nephropathy]]
+*[[Syndrome of inappropriate antidiuretic hormone secretion (siadh)]]
+*[[Thiazide diuretics]]
+*[[Triamterene]]
+*[[Villous adenoma]]
+*[[Vomiting]]
+*[[Water overload]]
+}}
+==Diagnosis==
+===Laboratory Findings===
+Normal values of Chloride are 99-111 mEq/L (99-111 mmol/L).
 ==References==
 {{Reflist|2}}
-==External links==
-* [http://www.fpnotebook.com/REN12.htm FP Notebook]
 {{Fluid, electrolyte, acid base metabolic pathology}}
 {{Endocrine, nutritional and metabolic pathology}}
+{{Intensive care medicine}}
 [[Category:Electrolyte disturbance]]
 [[Category:Inborn errors of metabolism]]