Hyperchloremia

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Hyperchloremia is an electrolyte disturbance in which there is an abnormally elevated level of the chloride ion in the blood. The normal serum range for chloride is 97 to 107 mEq/L. Hyperchloremia is defined as a chloride concentration exceeding this level.

Symptoms

Often hyperchloremia does not produce any symptoms. However, hyperchloremia is sometimes associated with excess fluid loss such as vomiting and diarrhea. If the sufferer is a diabetic, hyperchloremia may lead to poor control of blood sugar levels, causing them to become elevated. Hyperchloremia can be symptomatic with signs of Kussmaul's breathing, weakness, and intense thirst.

Causes

Elevations in chloride may be associated with diarrhea, certain kidney diseases, and overactivity of the parathyroid glands. Hyperchloremia is often comorbid with diabetes or hyponatremia. Certain drugs, especially diuretics such as carbonic anhydrase inhibitors, hormonal treatments, and polypharmacy, may contribute to this disorder.

Complete Differential Diagnosis of the Causes of Hyperchloremia

(In alphabetical order)

• Artifact (low anion gap)
• Dehydration
• Drugs
• Hypernatremia
• Hyperparathyroidism
• Ileul loops
• Loss of pancreatic secretion
• Metabolic acidosis
• Nephrotic syndrome
• Prolonged diarrhea
• Renal failure
• Renal tubular acidosis
• Respiratory alkalosis
• Ureteral colonic anastomosis

Complete Differential Diagnosis of the Causes of Hyperchloremia

(By organ system)

Cardiovascular	No underlying causes
Chemical / poisoning	Drugs
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	Hyperparathyroidism
Environmental	No underlying causes
Gastroenterologic	Ileul loops, Loss of pancreatic secretion, Prolonged diarrhea, Ureteral colonic anastomosis
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	No underlying causes
Nutritional / Metabolic	Dehydration, Hypernatremia, Metabolic acidosis
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Opthalmologic	No underlying causes
Overdose / Toxicity	Drugs
Psychiatric	No underlying causes
Pulmonary	Respiratory alkalosis
Renal / Electrolyte	Artifact (low anion gap), Dehydration, Hypernatremia, Metabolic acidosis, Nephrotic syndrome, Renal failure, Renal tubular acidosis, Respiratory alkalosis
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	Nephrotic syndrome, Renal failure, Renal tubular acidosis, Ureteral colonic anastomosis
Miscellaneous	No underlying causes

Treatment

As with most types of electrolyte imbalance, the treatment of high blood chloride levels is based on correcting the underlying cause.

• If the patient is dehydrated, therapy consists of establishing and maintaining adequate hydration.

• If the condition is caused or exacerbated by medications or treatments, these may be altered or discontinued, if deemed prudent.

• If there is underlying kidney disease (which is likely if there are other electrolyte disturbances), then the patient will be referred to a nephrologist for further care.

• If there is an underlying dysfunction of the endocrine or hormone system, the patient will likely be referred to an endocrinologist for further assessment.

External links

• FP Notebook