Hypochloremia

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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]

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 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.

Causes

Common causes

• Diarrhea

• Vomiting

• Gastric suction

• Renal failure

• Burns

• Excessive sweating

Complete Differential Diagnosis of the Causes of Hypochloremia

(By organ system)

Cardiovascular	Congestive heart failure
Chemical / poisoning	No underlying causes
Dermatologic	Excessive sweating
Drug Side Effect	Aldosterone, Antacid abuse, Bicarbonate containing medication, Corticosteroids, Corticotropin, Laxatives, Loop diuretics, Thiazide diuretics
Ear Nose Throat	No underlying causes
Endocrine	ACTH-secreting tumor, Adrenal insufficiency, Cushing's syndrome, Diabetic coma, Hyperaldosteronism, Hyponatremia, Pseudohyponatremia, Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
Environmental	No underlying causes
Gastroenterologic	Bulimia nervosa, Diarrhea, Gastric suction, Gastrocolic fistula, Gastroesopahgeal reflux disease, Pyloric stenosis, Villous adenoma, Vomiting
Genetic	Cystic fibrosis, Bartter's syndrome
Hematologic	No underlying causes
Iatrogenic	Excessive saline infusion, Massive blood transfusion, Gastric suction
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	Excessive sweating
Nutritional / Metabolic	Low sodium diet, Metabolic alkalosis, Milk Alkali syndrome, Overconsumption of licorice
Obstetric/Gynecologic	No underlying causes
Oncologic	ACTH-secreting tumors
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Bulimia nervosa
Pulmonary	Respiratory losses, Hypoventilation
Renal / Electrolyte	Hyponatremia, Renal failure, Salt-losing nephritis, Bartter's syndrome
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Burns
Urologic	Renal failure
Miscellaneous	No underlying causes

Causes in alphabetical order

• ACTH-secreting tumors

• Adrenal insufficiency

• Aldosterone

• Antacid abuse

• Bartter's syndrome

• Bicarbonate containing medication

• Bulimia nervosa

• Burns

• Congestive heart failure

• Corticosteroids

• Corticotropin

• Cushing's syndrome

• Cystic fibrosis

• Diabetic coma

• Diarrhea

• Excessive saline infusion

• Excessive sweating

• Gastric suction

• Gastrocolic fistula

• Gastroesopahgeal reflux disease

• Hyperaldosteronism

• Hyponatremia

• Hypoventilation

• Laxatives

• Loop diuretics

• Low sodium diet

• Massive blood transfusion

• Metabolic alkalosis

• Milk alkali syndrome

• Overconsumption of licorice

• Pseudohyponatremia

• Pyloric stenosis

• Renal failure

• Respiratory losses

• Salt-losing nephritis

• Syndrome of inappropriate antidiuretic hormone secretion(SIADH)

• Thiazide diuretics

• Villous adenoma

• Vomiting

Diagnosis

Laboratory Findings

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

External links

• FP Notebook

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