What is Chloride?
Ions are important in many bodily functions, such as water balance. One of these important ions is chloride. Along with other electrolytes (eg., potassium, sodium), it plays a role in the body’s acid-base balance, as well as in the movement of fluid through the cells. Low chloride levels cause sickness and dehydration, whereas high levels can mean kidney problems.
Quick Facts
- Chloride channels are proteins responsible for the transport of chloride ions in the cell membrane.
- These proteins regulate cell volume and ion homeostasis.
- The chloride normal serum level is between 96 to 106 mEq/L.
- The buffer system needed for chloride to stay in a normal range is the bicarbonate/carbon dioxide chemical balance system.
- The kidneys play a role in maintaining the chloride levels of the body. There are transporters in the cells along the nephron of the kidneys that play this major role.
- Chloride ions are measured by using a silver-chloride electrode. It may be direct or indirect using a serum sample (from blood).
Hyperchloremia
Is the above-normal concentration of chloride ions in the plasma or in the extracellular fluid (ECF). This is experienced when there is bicarbonate loss in the gastrointestinal area. This means there is an excess of chloride in the ECF (extracellular fluid of the cells).
Conditions with hyperchloremia
- Fever
- Increased room temperature
- Perspiration
- Inadequate water intake
- Loss of thirst perception: commonly elderly patients
- Central diabetes insipidus
- Nephrogenic diabetic insipidus
- Diarrhea
- Burns
- Osmotic diuresis
- Diuretics
- Postobstructive diuresis
- Intrinsic renal disease
- Administration of 3 to 5% NaCl
- Saltwater drowning
- Saline absorption: large volume administration of 0.9 saline chloride solution–this is why it is important to track the fluid administration in every patient
- Acetazolamide medication
- Renal tubular acidosis
- Carbonic anhydrase inhibitor administration
- Ureteral diversion: one example of this is ileal bladder
- Ammonium chloride administration
- Kidney disease: there are certain cases of kidney diseases that can be attributed to increased chloride levels
Treatment
- Increase fluid intake
- Stop chloride administration
- Administer bicarbonate when metabolic acidosis occurs
Nursing Management
- The patient should be educated on the benefits of proper fluid intake.
- Assess the patient’s ability to taste and relay it to the physician.
- Check the patient’s laboratory for any changes in the blood serum chloride levels.
- Check fluid input and output of patients.
- Track the administered medicines and fluid replacements to the patients.
- Check the patient’s mental status upon giving medications.
Hypochloremia
This occurs when there’s a below-normal concentration of serum chloride in the body. This is a result of a loss of chloride from the ECF (extracellular fluid of the cell).
Conditions with Hypochloremia
- Vomiting
- Burns
- Salt-losing nephropathy
- Nasogastric suction
- Small bowel fistulas
- Inadequate NaCl intake
- Diuretic abusers
- Interstitial nephritis
- Adrenal insufficiency
- Hypertonic infusions
- Hyperglycemia at an early stage
- Intrinsic renal diseases
- Pathologic water drinkers
- Hypothyroidism
- Drugs: such as barbiturates, clofibrate, nicotine, morphine, and chlorpropamide
- Congestive heart failure
- Cirrhosis of the liver
- Nephrotic syndrome
- Compensated respiratory acidosis
- Metabolic alkalosis
Treatment
- Normal saline: is an isotonic solution to replace sodium and chloride loss
- Potassium and Chloride: to replace potassium and chloride
- Lysine monochloride: acid replacement for the depletion of chloride and metabolic alkalosis
- Arginine monochloride: one of the replacements used in conditions of metabolic alkalosis
- Ammonium chloride (HCl): also used for acid replacement for severe metabolic alkalosis
Nursing Management
- Encourage the patient to drink an adequate amount of fluid per day as recommended.
- Monitor input and output of patients.
- Check the administered medication that may lower the chloride level of the patient.
- Check the patient’s blood pressure as it may go lower due to lower chloride levels.
