Major Electrolyte Levels in the Blood: Chloride

Major Electrolyte Levels in the Blood: Chloride
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  • 0:01 The Lesser Known Half
  • 0:44 What Is Hyperchloremia?
  • 1:15 Why Does Hyperchloremia Occur?
  • 4:03 What Is Hypochloremia?
  • 5:56 Lesson Summary
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Lesson Transcript
Instructor: Artem Cheprasov
This lesson will discuss the importance of the chloride ion in diagnostic testing. You'll learn in which major conditions it can be elevated or decreased in the serum.

The Lesser-Known Half

You've heard of the term 'evil twin,' or the flip side of something, or someone else's better half. Well, I'm going to introduce you to the little-known, or little-mentioned, flip side and better half of table salt in this lesson.

Everyone has heard of sodium and how you should cut back on sodium in your diet. The sodium ion, a sodium atom with an electric charge, is also helpful in diagnosing disease processes that cause its elevations or decreases within the body.

But so many people forget about sodium's better half, the chloride ion. When combined together, they create NaCl, or table salt. Hence, the chloride ion will be the focus of this lesson, and I will show you how it's an important part of blood tests.

What Is Hyperchloremia?

The levels of chloride ion (Cl-) in the body are measured by taking a sample of blood. In some cases, hyperchloremia may be found on the blood test. Hyperchloremia refers to a serum chloride concentration of more than 105 mEq/L. Serum is the portion of your blood where electrolytes, such as sodium, potassium, calcium, and chloride, are found. Electrolytes are compounds that dissolve in liquid to form ions.

Why Does Hyperchloremia Occur?

Elevations of chloride, hyperchloremia, can occur due to many reasons. For example, if you are dehydrated and the amount of chloride within your body remains the same, then the concentration of it will increase. If this is confusing, then let's think about it another way.

Let's go have some fun instead and go bobbing for apples. Let's pretend each apple is a chloride ion. The water they are suspended in is our blood. In the beginning, there are 5 apples in the barrel and there are 10 gallons of water. If we keep the amount of water the same but add in 20 more apples, we have increased the amount of apples to 25. But there's still only 10 gallons of water. Therefore, our concentration of apples has increased. Conversely, if we start over and we decrease the amount of water in the barrel by siphoning off 5 gallons, then the amount of apples per volume of water has just increased as well! Therefore, their concentration has increased, and that's what happens in dehydration.

Another important condition we may see hyperchloremia in is hyperchloremic metabolic acidosis. This is a condition where relatively low levels of bicarbonate lead to acidosis in the body, with concomitant elevations in chloride ion concentration.

Basically (pun fully intended), bicarbonate acts as a base that helps to neutralize the acidic hydrogen ions in your body. If bicarbonate is lost due to prolonged diarrhea or a problem with the kidneys, then the amount of acidic hydrogen ions in your body increases in relative proportion to bicarbonate, causing acidosis. The question should be why chloride concentration increases in this case?

Well, if you have diarrhea, then you are losing a lot of water in addition to sodium, bicarbonate, and plenty of other stuff. This results in acidosis and hypovolemia, or low blood volume. Since low blood volume is dangerous to your health, your kidneys begin to reabsorb as much sodium as possible because water follows sodium into the body. By absorbing more sodium, more water enters the vasculature in hopes of normalizing the blood volume. But the catch is that sodium is absorbed with chloride in the kidneys, and this is one reason for the resulting hyperchloremia.

Other causes for hyperchloremia include:

  • Administration of chloride-containing substances, such as certain drugs and IV fluids
  • Cystic fibrosis
  • Hyperparathyroidism

What Is Hypochloremia?

The other side to chloride ion concentrations in the body is hypochloremia. Hypochloremia is a serum chloride concentration of less than 95 mEq/L.

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