Hypochloremia: Difference between revisions

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{{DiseaseDisorder infobox |
__NOTOC__
  Name        = {{PAGENAME}} |
  ICD10      = {{ICD10|E|87|8|e|70}} |
  ICD9        = {{ICD9|276.9}} |
}}
{{SI}}
{{SI}}
{{CMG}}
{{CMG}}; {{AOEIC}}{{ADI}}
 
{{SK}} Hypochloraemia


==Overview==
==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)
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>


Primary anion of [[extracellular fluid]] compartment; aids in maintenance of acid-base balance.
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>


==Causes==  
==Causes==  
===Common causes===
===Common Causes===
*[[Diarrhea]]
*[[Diarrhea]]
*[[Vomiting]]
*[[Vomiting]]
*[[Gastric suction]]
*[[Gastric suction]]
*[[Renal failure]]
*[[Renal failure]]
*[[Burns]]
*[[Burns]]
*[[Excessive sweating]]
*[[Excessive sweating]]


===Complete Differential Diagnosis of the Causes of Hypochloremia===
===Causes by Organ System===
(By organ system)
{|style="width:70%; height:100px" border="1"
{|style="width:70%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Aldosterone]], [[Antacid abuse]], [[Bicarbonate containing medication]], [[Corticosteroids]], [[Corticotropin]], [[Laxatives]], [[Loop diuretics]], [[Thiazide diuretics]]
|bgcolor="Beige"| [[Aldosterone]], [[Antacid abuse]], [[Bendrofluazide]], [[Corticosteroids]], [[Corticotropin]], [[Frusemide]],  [[Hydrochlorothiazide]],  [[Hyperaldosteronism]],  [[Laxatives]], [[Loop diuretics]], [[Metolazone]],  [[Thiazide diuretics]],  [[Triamterene]]  
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
| '''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"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Bulimia nervosa]], [[Diarrhea]], [[Gastric suction]],  [[Gastrocolic fistula]], [[Gastroesopahgeal reflux disease]],  [[Pyloric stenosis]], [[Villous adenoma]], [[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"
|-bgcolor="LightSteelBlue"
| '''Genetic'''
| '''Genetic'''
|bgcolor="Beige"| [[Cystic fibrosis]], [[Bartter's syndrome]]
|bgcolor="Beige"| [[Acute intermittent porphyria]]
 
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
| '''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"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
| '''Neurologic'''
|bgcolor="Beige"| [[Excessive sweating]]
|bgcolor="Beige"| [[Diabetic coma]],  [[Syndrome of inappropriate antidiuretic hormone secretion (siadh)]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| [[Low sodium diet]], [[Metabolic alkalosis]], [[Milk Alkali syndrome]], Overconsumption of [[licorice]]
|bgcolor="Beige"| [[Diabetic coma]],  [[Low sodium diet]], [[Metabolic alkalosis]], [[Overconsumption of licorice]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
| '''Oncologic'''
|bgcolor="Beige"| [[ACTH]]-secreting tumors
|bgcolor="Beige"| [[Acth-secreting tumors]],  [[Villous adenoma]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
| '''Pulmonary'''
|bgcolor="Beige"| Respiratory losses, [[Hypoventilation]]
|bgcolor="Beige"| [[Gastroesophageal reflux disease]],  [[Hypoventilation]],  [[Respiratory acidosis]], [[Respiratory losses]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Hyponatremia]], [[Renal failure]], Salt-losing [[nephritis]], [[Bartter's syndrome]]
|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"
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| No underlying causes
|bgcolor="Beige"| [[Cushing's syndrome]],  [[Cystic fibrosis]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
| '''Trauma'''
| '''Trauma'''
|bgcolor="Beige"| [[Burns]]
|bgcolor="Beige"| [[Burns]],  [[Vomiting]]
|-
|-
|-bgcolor="LightSteelBlue"
|-bgcolor="LightSteelBlue"
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|}
|}


===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>===
===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]]
}}


* [[ACTH]]-secreting tumors
==Diagnosis==
* [[Adrenal insufficiency]]
===Laboratory Findings===
* [[Bulimia nervosa]]
Normal values of Chloride are 99-111 mEq/L (99-111 mmol/L).
* [[Burns]]
* [[Congestive heart failure]]
* [[Cushing's syndrome]]
* [[Diabetic]] [[coma]]
* [[Diarrhea]]
* [[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]]


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


==External links==
* [http://www.fpnotebook.com/REN12.htm FP Notebook]




Latest revision as of 21:20, 10 January 2020

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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

  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)
  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


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