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.
Template:Endocrine, nutritional and metabolic pathology