Hyperchloremia
Hyperchloremia | |
---|---|
Chlorine | |
Specialty | Endocrinology |
Hyperchloremia is an
Hyperchloremia prevalence in hospital settings has been researched in the medical field since one of the major sources of treatment at hospitals is administering
Symptoms
Hyperchloremia does not have many noticeable symptoms and can only be confirmed with testing, yet, the causes of hyperchloremia do have symptoms.
Symptoms of the above stated abnormalities may include:[5]
- Dehydration - due to diarrhea, vomiting, sweating
- Hypertension - due to increased sodium chloride intake
- Cardiovascular dysfunction - due to increased sodium chloride intake
- Edema - due to influx in sodium in the body
- Weakness - due to loss of fluids
- Thirst - due to loss of fluids
- Kussmaul breathing - due to high ion concentrations, loss of fluids, or kidney failure
- High blood sugar - due to diabetes
- Hyperchloremic metabolic acidosis - due to severe diarrhea and/or kidney failure
- Respiratory alkalosis - due to renal dysfunction
Causes
There are many scenarios which may results in hyperchloremia. The first instance is when there is a loss of electrolyte-free fluid. This simply means that the body is losing increased amounts of fluids that do not contain electrolytes, like chloride, resulting in high concentration of these ions in the body. This loss of fluids can be due to sweating (due to exercise or fever), skin burns, lack of adequate water intake, hyper-metabolic state, and diabetes insipidus. Losing fluids can lead to feelings of dehydration and dry mucous membrane.[4][5]
The second scenario that may lead to hyperchloremia is known as loss of hypotonic fluid which can be a direct result of loss of electrolyte fluid. Normally, water in the body is moving from an area of low ion concentration to an area of high ion concentration. In this case, the water is being excreted in the urine, therefore, less water is available to dilute these areas of high ion concentration. This can be due to diuretic use, diarrhea, vomiting, burns, kidney disease, kidney failure, and renal tubular acidosis . This may also lead to feeling of dehydration.[4][5]
The third scenario that may lead to hyperchloremia is an increase in sodium chloride intake. This can be due to dietary intake or intravenous fluid administration in hospital settings. This can lead to the body experiencing hypertension, edema, and cardiovascular dysfunction.[4][5]
Mechanism
The
Normally, chloride reabsorption begins in the
One suggested mechanism leading to hyperchloremia, there is a decrease in chloride transporter proteins along the nephron. These proteins may include sodium-potassium-2 chloride co-transporter, chloride anion exchangers, and chloride channels. Another suggested mechanism is a depletion in concentration gradient as a result of the reduced activity in these transporters. Such concentration gradient depletion would allow for the passive diffusion of chloride in and out the tubule.[7]
Diagnosis
Elevated levels of chloride in the blood can be tested simply by requesting a
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[1] such as drinking 2-3 quarts of water daily. Also, to alleviate symptoms of dehydration like diarrhea or vomiting, it is suggested to take medication.[9]
- If the condition is caused or exacerbated by medications or treatments, these may be altered or discontinued, if deemed prudent.[1][9]
- 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.[1]
- If there is an underlying dysfunction of the endocrine or hormone system, the patient will likely be referred to an endocrinologist for further assessment.[1]
- If the electrolyte imbalance is due to influx of sodium chloride in the body, then it has been suggested to make dietary changes or reduce the rate of administering intravenous fluids.[4]
Recent research
In patients with sepsis or septic shock they are more susceptible to experience acute kidney injury (AKI) and the factors that may contribute to AKI are still being investigated. In a study conducted by Suetrong et al., (2016) using patients admitted to St. Paul Hospital in Vancouver with sepsis or septic shock had their body concentration of chloride checked over the course of 48 hours to determine if there is a relation between hyperchloremia and AKI. This is an important relationship to study because many times a form of therapy to treat sepsis and septic shock is to administer saline solution, which is a solution containing sodium chloride. Saline has a much higher concentration of chloride than blood. In this study they defined hyperchloremia as concentration of chloride greater than 110 mmol/L. This research demonstrated that hyperchloremia will influence a patient developing AKI. In fact, even patients that had a conservative increase in serum chloride saw some association with developing AKI. This research study suggest that there still needs to be more investigation in the risk of using saline as a form of therapy and the risk of experiencing AKI.[10]
In a separate study investigating the relation of critically ill patients and hyperchloremia, researchers found that there seems to be an independent association between ill patients with hyperchloremia and
Several trials have been done comparing balanced fluid (chloride restricted) solution with saline (chloride liberal) with the hypothesis that it may reduce the risk of AKI and mortality. Initial randomized trials in septic shock comparing Plasma-Lyte and 0.9% saline (SPLIT and SALT trials) did not show any risk reduction in AKI.[12][13] However, the later trials with larger sample size in critically and non critically ill adults (SMART and SALT-ED trials) showed reduction in major adverse kidney events.[14][15] Extrapolating from the findings of septic shock, a recent trial comparing plasmalyte with 0.9% saline in DKA also did not show any significant difference in AKI. Hence, the causal link between hyperchloremia and AKI is yet to be conclusively established.[16]
As studies continue, it is important to include a large patient sample size, a diverse patient population, and a diverse range of hospitals involved in these studies.[4]
References
- ^ S2CID 1778217.
- ^ a b c "Chloride test - blood: MedlinePlus Medical Encyclopedia". medlineplus.gov. Retrieved 2017-12-12.
- ^ a b "Hyperchloremic metabolic acidosis". dynamed.com. Archived from the original on 2019-02-13. Retrieved 2017-12-12.
- ^ PMID 29123653.
- ^ PMID 21250151.
- ^ ISBN 978-1455770052.)
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: CS1 maint: multiple names: authors list (link - ^ PMID 27267918.
- ^ Cancer, Cleveland Clinic. "Hyperchloremia (High Chloride) - Managing Side Effects - Chemocare". chemocare.com. Archived from the original on 2020-03-27. Retrieved 2017-12-12.
- ^ a b "Hyperchloremia (high chloride): Symptoms, causes, and treatments". Medical News Today. Retrieved 2017-12-13.
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