Chloride

Chloride is an important element that is counted among the electrolytes (blood salts). Chloride is the main anion of extracellular fluid (fluid located outside the body cells). Chloride concentration usually changes analogously to sodium concentration. Chloride is of importance in acid-base and electrolyte (salt)-water balance.

The process

Material needed

  • Blood serum

Preparation of the patient

  • Not necessary

Disruptive factors

  • Not known

Normal values – blood

Standard values in mmol/l
Newborn 95-112
Infants 95-112
Children 95-112
Adults 96-110

Indications

  • Suspected acid-base balance disorders.

Interpretation

Interpretation of elevated levels (in serum; hyperchloremia/hyperchloridemia).

  • Ingestion of chloride (ammonium chloride; arginine chloride; lysine chloride).
  • Administration of bromide
  • Hyperventilation (chronic) – breathing beyond the need e.g. due tofever, CNS- diseases.
  • Renal tubular acidosis (hyperchloremic metabolic acidosis) – congenital or acquired renal disorder of acid-base balance.
    • Autoimmune diseases
    • Diabetes mellitus
    • Interstitial nephropathy
    • Genetic cause
    • After urethro-enteral surgery – for example, after ureterosigmoidostomy (surgical connection between the ureter and the colon after removal of the urinary bladder).
    • After administration of amphotericin B

Interpretation of decreased values (in serum; hypochloremia/hypochloridemia).

  • Metabolic (metabolic) alkalosis – excessive base content in the blood.
    • Hyperaldosteronemia – excessive blood levels of aldosterone; needed primarily for fluid regulation.
    • Cushing’s disease (Cushing’s syndrome) – disease in which too much ACTH is produced by the pituitary gland, resulting in increased stimulation of the adrenal cortex and, as a consequence, excessive production of cortisol
    • ACTH-forming tumors
    • Bartter syndrome – very rare metabolic disorder associated mainly with hyperaldosteronism and consequently hypokalemia (potassium deficiency).
    • Milk alkali syndrome (Burnett syndrome) – disease caused by an excess of alkalis such as milk and calicum carbonate.
  • Respiratory (respiratory) alkalosis – due to hyperventilation (accelerated breathing that is faster and sometimes deeper than the body’s metabolism requires).
  • Taking diuretics (dehydrating medications).
    • Etacrynic acid
    • Furosemide
  • Intestinal loss of chloride
    • Chronic vomiting
    • Gastric drainage
    • Congenital chloridorrhea – diarrhea (diarrhea) caused by chloride malabsorption.