- Symptoms
- Chlorine functions
- Most frequent symptoms
- Cardiovascular
- Neurological
- Muscular
- Respiratory
- Causes
- Lack of chlorine supply
- Gastrointestinal
- Medications
- Metabolic
- Skin lesions
- Congenital diseases
- Kidney disease
- Other causes
- Consequences
- Treatment
- References
The hypochloraemia is the low concentration of chlorine in blood. The normal plasma range for chlorine is between 95 and 105 mEq / L, which is why a value below 95 mEq / L is considered hypochloremia. Chlorine deficiency produces an electrolyte imbalance that affects the body's homeostasis.
Chlorine is a bioelement present in living beings in the form of chloride. It is a predominantly extracellular anion whose lack causes an imbalance of organic functions. It is closely related to sodium, which acts in its regulation.
Chlorine's functions in the body include regulation of body water and osmolarity, and participation in various chemical reactions. The deficiency of this anion in isolation is not frequent, and is associated with the deficiency of other electrolytes or alterations of the acid-base balance.
Hypochloremia occurs due to poor intake, failure of its regulatory mechanism, or increased excretion. The importance of chlorine in vital functions makes its deficit produce multiple functional alterations and associated symptoms.
The treatment of hypochloremia will depend on the cause that originates it. The objective of this treatment will be to correct the deficiency and restore homeostasis - or balance - of the body.
Symptoms
Due to its presence in most of the body and the functions it performs, a low concentration of chlorine produces a wide variety of symptoms.
Furthermore, the clinical symptoms will depend on those caused by sodium deficiency or acid-base imbalance that usually accompany hypochloremia.
Chlorine functions
- Contributes to the maintenance of the acid-base balance of the body. The chloride concentration contributes to organic electroneutrality. Being an anion, its negative charge compensates for the charge of other ions.
- Regulates water content and plasma osmolarity, which guarantees cell integrity.
- It is a component of the transmission of the nerve impulse in the central and peripheral areas.
- It is part of the muscles, so it is involved in muscle function.
- Hydrochloric acid present in gastric juice is synthesized from chloride. Consequently, the chloride intervenes in the digestion process.
- Allows red blood cells to maintain their cellular integrity.
- Collaborates in the production of blood plasma.
Most frequent symptoms
Hypochloremia is closely related to hyponatremia or sodium deficiency in the blood. In this case, the decrease in ions has to do with the decrease in plasma osmolarity, in relation to the extracellular water volume. Additionally, hypochloremia is often present in respiratory acidosis and metabolic alkalosis.
The symptoms of low chloride concentration are a consequence of the causes and accompanying disorders:
Cardiovascular
Sometimes the loss of fluid leads to hypovolemia, with signs of shock appearing. The role of chlorine in myocardial contraction produces heart rhythm disturbances:
- Arterial hypotension.
- Tachycardia.
- Signs of tissue hypoperfusion, including paleness and sweating.
- Ventricular arrhythmias.
Neurological
- Asthenia or general weakness.
- Irritability and mood swings.
- Exacerbated tendon reflexes.
- Psychomotor agitation.
- Tremors.
- Seizures.
- Eat.
Muscular
- Myalgia.
- Increased muscle tone.
- Painful paresthesias.
- Tetany.
Respiratory
- Breathing difficulties.
- Deep and prolonged breaths.
- chest pain
Causes
Vomiting, one of the causes of hypochloremia
The main cause of hypochloremia is leakage due to vomiting, diarrhea, and the use of nasogastric tubes. Chlorine is present in gastric juices as hydrochloric acid and, when expelled in vomit or with nasogastric suction, its concentration in the body decreases.
In these cases, potassium is also lost, which is bound to chlorine as potassium chloride. Among the causes of hypochloremia can be found the following:
Lack of chlorine supply
- Decrease in intake, such as low consumption of salt (sodium chloride) or foods that contain it.
- Decreased absorption.
Gastrointestinal
- Chronic diarrhea.
- Enterocolitis.
- Ilio paralytic.
Medications
- Hydration with non-saline solutions, such as glucose solutions. Overhydration is also a cause of hypochloremia.
- Use of thiazide and loop diuretics, such as furosemide.
- Laxatives.
- Steroids.
- Baking soda.
Metabolic
- Metabolic alkalosis.
- Anion gap-dependent metabolic acidosis.
- Diabetic cetoacidosis.
- Diabetes insipidus.
Skin lesions
- Extensive burns.
- Trauma and open wounds.
- Excessive sweating.
Congenital diseases
- Barrter syndrome. This disease presents with hypochloremia, hypokalemia, metabolic alkalosis and hypercalciuria, due to a defect of the loop of Henle.
- Cystic fibrosis.
- Inappropriate secretion of antidiuretic hormone.
Kidney disease
- Renal insufficiency.
- Renal tubular acidosis
Other causes
- Respiratory acidosis.
- Hyperventilation
- Edematous syndromes, consisting of accumulation of fluid in the interstitial space.
- Ascites. The evacuation or drainage of ascites fluid represents a great loss of electrolytes, including chlorine.
- Heart failure.
Consequences
Alterations in the hydric, electrolyte and metabolic balance are consequences associated with hypochloremia. Due to being accompanied by other electrolyte disorders, there is no clear idea of the effects of the chlorine deficiency. Some consequences that are evident in this alteration are the following:
- Hyponatremia, or sodium deficiency.
- Hypokalemia, hypokalaemia or decrease in serum potassium.
- Hypercalcemia.
- Increase in bicarbonate, which is a compensatory response to the decrease in chlorine. Metabolic alkalosis is due to this.
- Respiratory acidosis.
- Decrease in extracellular fluid. Dehydration
- Increased reabsorption of electrolytes at the renal level.
- Alteration of nerve impulse conduction.
- Dysfunction of contractility and muscle tone.
- Loss of cell integrity, such as hemolysis.
Treatment
Prior to the treatment of hypochloremia, the cause must be determined, which is done through questioning, physical examination and laboratory tests. The determination of serum electrolytes is important to quantify their deficit.
The ideal treatment for hypochloremia aims to:
- Establish the appropriate therapy for the cause.
- Correct the alteration of electrolytes, including chlorine.
- Treat acid-base imbalance.
Hydration with saline solution - sodium chloride solution - is the therapy of choice. Potassium chloride provides both electrolytes, so it must be combined with saline when required. It is infrequent to perform calculations to correct the concentration of chlorine, since it is not an isolated alteration.
The treatment of low concentrations of chlorine and other electrolytes, in addition to the replacement of fluids, implies the recovery of the body's homeostasis.
References
- Kamel, G (2014). Chloride. Recovered from emedicine.medscape.com
- Euromd (2014). Why body needs chlorine ?. Recovered from euromd.com
- Encyclopaedia britannica editors (last rev 2011) Chlorine deficiency. Recovered from britannica.com
- (sf). Hypochloremia. Recovered from medigoo.com
- Seladi-Schulman, J (2017). Hypochloremia: What Is It and How Is It Treated ?. Recovered from healthline.com
- Narsaria, R (2017). Hypochloremia. Recovered from mediindia.net
- (sf) Hypochloremia (low chloride). Recovered from chemocare.com
- Madias NE, Homer SM, Johns CA, Cohen JJ. (1984). Hypochloremia as a consequence of anion gap metabolic acidosis.
- Gullapali, R; Virji, MA (sf) Final Diagnosis - Hypochloremic metabolic alkalosis. Recovered from path.upmc.edu