387:
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.
55:
404:
show any risk reduction in AKI. 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. 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.
29:
961:
Henry J.; Wang, Li; Wanderer, Jonathan P.; Ehrenfeld, Jesse M.; Shaw, Andrew D.; Hernandez, Antonio; Kumar, Avinash B.; Self, Wesley H.; Siew, Edward D.; Dunlap, Debra F.; Stollings, Joanna L.; Sullivan, Mark; Knostman, Molly; Mulherin, David P.; Hargrove, Fred R.; Janz, David R.; Strawbridge, Seth (2017-05-15).
1018:
Semler, Matthew W.; Self, Wesley H.; Wanderer, Jonathan P.; Ehrenfeld, Jesse M.; Wang, Li; Byrne, Daniel W.; Stollings, Joanna L.; Kumar, Avinash B.; Hughes, Christopher G.; Hernandez, Antonio; Guillamondegui, Oscar D.; May, Addison K.; Weavind, Liza; Casey, Jonathan D.; Siew, Edward D.; Shaw, Andrew
960:
Semler, Matthew W.; Wanderer, Jonathan P.; Ehrenfeld, Jesse M.; Stollings, Joanna L.; Self, Wesley H.; Siew, Edward D.; Wang, Li; Byrne, Daniel W.; Shaw, Andrew D.; Bernard, Gordon R.; Rice, Todd W.; Bernard, Gordon R.; Semler, Matthew W.; Noto, Michael J.; Rice, Todd W.; Byrne, Daniel W.; Domenico,
336:
levels for a prolonged period of time. For the test to occur a healthcare provider must draw a sample of blood from the patient. The sample will then be sent to a laboratory and results will be provided to the patient's physician. As mentioned earlier a normal serum chloride range is from 96 to 106
206:
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
403:
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
386:
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
304:
ions are reabsorbed from the filtrate fluid into the interstitial fluid. This is an important step because this creates the concentration gradient in which chloride concentration in the lumen will increase in comparison to the chloride concentration in the interstitial fluid. In phase 2, chloride
283:
and nearly 60% of chloride is filtered here. In a person with hyperchloremia, the absorption of chloride into the interstitial fluid and subsequently into the blood capillaries is increased. This means the concentration of chloride in the filtrate is decreased, therefore, a decreased amount of
230:
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
399:
were accounted for. This study is important because this continues to suggest there is increased risk associated with elevated chloride levels in vulnerable populations. Their article also states there needs to be avoidance of using solutions with chloride in specific patient subgroups
87:
dysfunction as it is a regulator of chloride concentration. As of now there are no specific symptoms of hyperchloremia; however, it can be influenced by multiple abnormalities that cause a loss of electrolyte-free fluid, loss of hypotonic fluid, or increased administration of
138:, and less renal blood flow as well at glomerulus filtration, all of which are prompting researchers to investigate if these changes or others may exist in patients. Some studies have reported a possible relationship between increased chloride levels and death or
1076:
Self, Wesley H.; Semler, Matthew W.; Wanderer, Jonathan P.; Wang, Li; Byrne, Daniel W.; Collins, Sean P.; Slovis, Corey M.; Lindsell, Christopher J.; Ehrenfeld, Jesse M.; Siew, Edward D.; Shaw, Andrew D.; Bernard, Gordon R.; Rice, Todd W. (March 2018).
1227:
1212:
238:
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
910:
Young, Paul; Bailey, Michael; Beasley, Richard; Henderson, Seton; Mackle, Diane; McArthur, Colin; McGuinness, Shay; Mehrtens, Jan; Myburgh, John; Psirides, Alex; Reddy, Sumeet; Bellomo, Rinaldo (2015-10-27).
390:
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
275:
waiting to reabsorb ions from the interstitial fluid to circulate in the body. The amount of chloride to be released in the urine is due to the receptors lining the nephrons and the glomerulus filtration.
267:
are responsible for regulating the level of chloride in the blood. The general mechanism is that as filtrate fluid passes through the nephrons varying concentrations of ions will be secreted into the
316:. 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
373:
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.
1270:
112:. Hyperchloremia should not be mistaken for hyperchloremic metabolic acidosis as hyperchloremic metabolic acidosis is characterized by two major changes: a decrease in blood
671:
407:
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.
231:
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,
123:
Hyperchloremia prevalence in hospital settings has been researched in the medical field since one of the major sources of treatment at hospitals is administering
284:
chloride is being excreted as waste in the urine. In the proximal tubule chloride reabsorption occurs in two parts. In the 1st phase, organic solutes (such as
738:
508:
913:"Effect of a Buffered Crystalloid Solution vs Saline on Acute Kidney Injury Among Patients in the Intensive Care Unit: The SPLIT Randomized Clinical Trial"
120:
levels, as well as an increase in blood chloride levels. Instead those with hyperchloremic metabolic acidosis are usually predisposed to hyperchloremia.
305:
will diffuse along the concentration gradient, which means chloride ions will travel from areas of high concentration to areas of low concentration.
1462:
1263:
1136:"0.9% saline versus Plasma-Lyte as initial fluid in children with diabetic ketoacidosis (SPinK trial): a double-blind randomized controlled trial"
150:
Hyperchloremia does not have many noticeable symptoms and can only be confirmed with testing, yet, the causes of hyperchloremia do have symptoms.
359:
If there is underlying kidney disease (which is likely if there are other electrolyte disturbances), then the patient will be referred to a
142:
in severely ill patients that may frequent the hospital or have prolonged visits. There are other studies that have found no relationship.
1365:
796:"Hyperchloremia and moderate increase in serum chloride are associated with acute kidney injury in severe sepsis and septic shock patients"
395:. This study was conducted with septic patients admitted to ICUs for 72 hours. Chloride levels were assessed at baseline and 72 hours, and
853:
Neyra, Javier A.; Canepa-Escaro, Fabrizio; Li, Xilong; Manllo, John; Adams-Huet, Beverley; Yee, Jerry; Yessayan, Lenar (September 2015).
1481:
1256:
655:
619:
345:
As with most types of electrolyte imbalance, the treatment of high blood chloride levels is based on correcting the underlying cause.
1551:
433:
Cambier C, Detry B, Beerens D, et al. (October 1998). "Effects of hyperchloremia on blood oxygen binding in healthy calves".
356:
If the condition is caused or exacerbated by medications or treatments, these may be altered or discontinued, if deemed prudent.
1457:
1325:
1313:
1528:
1476:
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of water daily. Also, to alleviate symptoms of dehydration like diarrhea or vomiting, it is suggested to take medication.
312:
along the nephron. These proteins may include sodium-potassium-2 chloride co-transporter, chloride anion exchangers, and
349:
If the patient is dehydrated, therapy consists of establishing and maintaining adequate hydration such as drinking 2-3
366:
If there is an underlying dysfunction of the endocrine or hormone system, the patient will likely be referred to an
746:
516:
1330:
1359:
1355:
68:
1518:
248:
80:
127:. Previously, animal models with elevated chloride have displayed more inflammation markers, changes in
1523:
1279:
396:
332:
test. A doctor would request this test if there are signs their patient is experiencing an imbalance in
190:
1134:
Williams, Vijai; Jayashree, Muralidharan; Nallasamy, Karthi; Dayal, Devi; Rawat, Amit (December 2020).
794:
Suetrong, Bandarn; Pisitsak, Chawika; Boyd, John H.; Russell, James A.; Walley, Keith R. (2016-10-06).
1421:
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625:
615:
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450:
333:
317:
309:
124:
43:
235:, kidney failure, and renal tubular acidosis . This may also lead to feeling of dehydration.
1434:
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135:
963:"Balanced Crystalloids versus Saline in the Intensive Care Unit. The SALT Randomized Trial"
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367:
280:
224:
216:
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855:"Association of Hyperchloremia with Hospital Mortality in Critically Ill Septic Patients"
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608:
Morrison, Gail (1990). Walker, H. Kenneth; Hall, W. Dallas; Hurst, J. Willis (eds.).
181:
48:
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566:
462:
360:
308:
One suggested mechanism leading to hyperchloremia, there is a decrease in chloride
240:
208:
481:
870:
706:
689:
446:
1471:
220:
187:
Hyperchloremic metabolic acidosis - due to severe diarrhea and/or kidney failure
117:
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1152:
812:
328:
Elevated levels of chloride in the blood can be tested simply by requesting a
289:
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1102:
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609:
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272:
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97:
93:
72:
36:
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293:
260:
337:
mEq/L, and hyperchloremic patients will have levels above this range.
1493:
1216:
383:
297:
264:
84:
739:"Hyperchloremia (High Chloride) - Managing Side Effects - Chemocare"
611:
Clinical
Methods: The History, Physical, and Laboratory Examinations
163:
Cardiovascular dysfunction - due to increased sodium chloride intake
178:- due to high ion concentrations, loss of fluids, or kidney failure
83:, therefore chloride levels at or above 110 mEq/L usually indicate
771:"Hyperchloremia (high chloride): Symptoms, causes, and treatments"
350:
244:
76:
1079:"Balanced Crystalloids versus Saline in Noncritically Ill Adults"
219:, and diabetes insipidus. Losing fluids can lead to feelings of
212:
1252:
1021:"Balanced Crystalloids versus Saline in Critically Ill Adults"
113:
967:
American
Journal of Respiratory and Critical Care Medicine
482:"Chloride test - blood: MedlinePlus Medical Encyclopedia"
153:
Symptoms of the above stated abnormalities may include:
271:
or absorbed into the lumen. All along the nephrons are
160:
Hypertension - due to increased sodium chloride intake
550:"Chloride in intensive care units: a key electrolyte"
1194:
1019:
D.; Bernard, Gordon R.; Rice, Todd W. (March 2018).
548:
Bandak, Ghassan; Kashani, Kianoush B. (2017-11-01).
1492:
1443:
1420:
1397:
1374:
1286:
1198:
79:. The normal serum range for chloride is 96 to 106
42:
21:
157:Dehydration - due to diarrhea, vomiting, sweating
279:Normally, chloride reabsorption begins in the
1264:
428:
426:
424:
422:
420:
8:
670:: CS1 maint: multiple names: authors list (
207:the body. This loss of fluids can be due to
166:Edema - due to influx in sodium in the body
1271:
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994:
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829:
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575:
565:
416:
71:in which there is an elevated level of
663:
614:(3rd ed.). Boston: Butterworths.
7:
1366:Familial hypocalciuric hypercalcemia
765:
763:
683:
681:
641:
639:
603:
601:
599:
597:
595:
543:
541:
539:
537:
535:
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503:
501:
476:
474:
472:
100:, increased sodium chloride intake,
92:. These abnormalities are caused by
1482:Hypokalemic sensory overstimulation
509:"Hyperchloremic metabolic acidosis"
320:of chloride in and out the tubule.
14:
215:, lack of adequate water intake,
169:Weakness - due to loss of fluids
1458:Hyperkalemic periodic paralysis
1326:Disorders of calcium metabolism
1083:New England Journal of Medicine
1025:New England Journal of Medicine
688:Nagami, Glenn T. (2016-07-01).
1529:Cerebral salt-wasting syndrome
1477:Hypokalemic periodic paralysis
690:"Hyperchloremia – Why and how"
648:Textbook of Medical Physiology
567:10.12688/f1000research.11401.1
172:Thirst - due to loss of fluids
1:
871:10.1097/CCM.0000000000001161
707:10.1016/j.nefroe.2016.06.006
694:Nefrología (English Edition)
447:10.1152/jappl.1998.85.4.1267
211:(due to exercise or fever),
1331:Hypercalcemia of malignancy
646:Hall, J, Guyton, A (2016).
1568:
979:10.1164/rccm.201607-1345OC
737:Cancer, Cleveland Clinic.
249:cardiovascular dysfunction
193:- due to renal dysfunction
1153:10.1186/s13054-019-2683-3
813:10.1186/s13054-016-1499-7
35:
26:
1552:Electrolyte disturbances
1360:Dystrophic calcification
1356:Metastatic calcification
930:10.1001/jama.2015.12334
370:for further assessment.
69:electrolyte disturbance
1280:Electrolyte imbalances
859:Critical Care Medicine
1095:10.1056/NEJMoa1711586
1037:10.1056/NEJMoa1711584
397:confounding variables
217:hyper-metabolic state
191:Respiratory alkalosis
1321:Milk-alkali syndrome
310:transporter proteins
300:), sodium ions, and
1305:Symptoms and signs
140:acute kidney injury
775:Medical News Today
269:interstitial fluid
176:Kussmaul breathing
1539:
1538:
1246:
1245:
973:(10): 1362–1372.
382:In patients with
363:for further care.
318:passive diffusion
314:chloride channels
273:blood capillaries
184:- due to diabetes
102:renal dysfunction
62:
61:
16:Medical condition
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505:
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182:High blood sugar
136:vasoconstriction
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480:
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380:
378:Recent research
368:endocrinologist
343:
326:
281:proximal tubule
257:
225:mucous membrane
204:
148:
125:saline solution
90:sodium chloride
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17:
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1507:Salt poisoning
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1323:
1318:
1317:
1316:
1314:Trousseau sign
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1199:Classification
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1352:Calcification
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411:References
286:phosphates
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1399:Magnesium
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