ISSN 2398-2969      

Hypochloremia

icanis

Introduction

  • Definition: serum chloride concentration < 105 mEq/L.

    Normal ranges and abnormal values are dependent on equipment used and reference ranges established for that equipment.
  • Chloride constitutes two thirds of the anion in the plasma and other components of the extracellular fluid.
  • Chloride is the major anion filtered by glomeruli and reabsorbed in the renal tubules.
  • Chloride ions play a role in determining osmolality and acid base status.

Pathogenesis

Pathophysiology

  • Change in chloride concentration caused by:
    • Loss of chloride ions.
    • Change in water balance (increase in free water). This is typically associated with a change in sodium concentration (hyponatremia Hyponatremia ).
  • Chloride needs to be corrected for changes in sodium (changes in water balance):
    [Cl] (corrected)= [Cl](measured) x [Na] (normal) / [Na] (measured)
  • Artifactual hypochloremia (low measured [Cl], with normal corrected [Cl] :
  • Corrected hypochloremia (this typically occurs with metabolic alkalosis).
  • Pseudo hypochloremia:
    • Lipemic or
    • Hyperproteinemic sample (secondary to titrimetric methods).
  • Excessive loss of chloride relative to sodium:
    • Vomiting of stomach contents.
    • Diuretic therapy ( thiazide and loop diuretics)
    • Chronic respiratory acidois.
    • Loss of plasma during exercise (especially in Greyhounds).
    • Trichuris vulpisinfection.
    • Hyperadenocorticism Hyperadrenocorticism.
  • Therapy with solution containing high sodium concentration relative to chloride

Diagnosis

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Treatment

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Biondo AW & De Morais H A (2008) Chloride a quick reference. Vet Clin Small Animal Practice 38 (3), 459-465 PubMed.
  • Schaer M (1999) Disorders of serum potassium, sodium, magnesium and chloride. J Vet Emerg Crit Care (4), 209-217 VetMedResource.
  • De Morais H A (1992) Chloride ion in small animal practice: the forgotten ion. J Vet Emerg Crit Care 2 (1), 11-24 VetMedResource.

Other sources of information

  • Small Animal Critical Care Medicine (2008) Eds D C Silverstein and K Hopper. Saunders Elsevier, St Louis, Missouri.
  • Fluid, Electrolytes and Acid-base Disorders in Small Animal Practice (2006) Eds S P DiBartola, Saunders Elsevier, St Louis Missouri.
  • The Veterinary ICU Book. (2002) Eds W E Wingfield and M R Raffee. Teton New Media, Jackson Hole, WY.

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