View source for Hypochloremia

{{Short description|Abnormally low levels of chloride in the blood}}
{{Infobox medical condition (new)
| name = Hypochloremia
| synonyms = 
| image = Cl-TableImage.svg
| caption = [[Chlorine]]
| pronounce = 
| field = 
| symptoms = 
| complications = [[Metabolic alkalosis]]<ref name=Sagar2024/>
| onset = 
| duration = 
| types = 
| causes = [[Vomiting]], [[Diuretics]]<ref name=Berend2012/>
| risks = 
| diagnosis = 
| differential = 
| prevention = 
| treatment = Treat underlying cause, salt and fluid intake{{fact|date=August 2025}}
| medication = 
| prognosis = 
| frequency = 
| deaths = 
}}
'''Hypochloremia''' (or '''Hypochloraemia''') is an [[electrolyte disturbance]] in which there is an abnormally low level of the [[chloride]] ion in the [[blood]]. Normal serum range for chloride is 97 to 107 mmol/L with levels less than 96 mmol/L defining hypochloremia.<ref>{{Cite journal |last1=Pfortmueller |first1=Carmen Andrea |last2=Uehlinger |first2=Dominik |last3=von Haehling |first3=Stephan |last4=Schefold |first4=Joerg Christian |date=April 2018 |title=Serum chloride levels in critical illness—the hidden story |journal=Intensive Care Medicine Experimental |volume=6 |issue=1 |page=10 |doi=10.1186/s40635-018-0174-5 |doi-access=free |issn=2197-425X |pmc=5899079 |pmid=29654387}}</ref>

Hypochloremia can contribute to [[metabolic alkalosis]]. Patients with mild hypochloremia may be asymptomatic. In significant chloride depletion and the resulting alkalosis, symptoms may include neuromuscular irritability, such as muscle cramps, twitching, and, in severe cases, seizures.<ref name=Sagar2024>{{Cite journal |last1=Sagar |first1=Nandin |last2=Lohiya |first2=Sham |date=March 2024 |title=A Comprehensive Review of Chloride Management in Critically Ill Patients |journal=Cureus |volume=16 |issue=3 |article-number=e55625 |language=en |doi=10.7759/cureus.55625 |doi-access=free |issn=2168-8184 |pmc=10995984 |pmid=38586759}}</ref>

Treatment involves diagnosing the underlying cause. Mild hypochloremia may be corrected by salt intake. For more severe hypochloremia, IV fluids may be given.{{fact|date=August 2025}}

It rarely occurs in the absence of other abnormalities. It is sometimes associated with [[hypoventilation]].<ref name="pmid3764530">{{cite journal |vauthors=Lavie CJ, Crocker EF, Key KJ, Ferguson TG |title=Marked hypochloremic metabolic alkalosis with severe compensatory hypoventilation |journal=South. Med. J. |volume=79 |issue=10 |pages=1296–9 |date=October 1986 |pmid=3764530 |doi= 10.1097/00007611-198610000-00025}}</ref> It can be associated with chronic [[respiratory acidosis]].<ref name="pmid13611033">{{cite journal |vauthors=Levitin H, Branscome W, Epstein FH |title=The pathogenesis of hypochloremia in respiratory acidosis |journal=J. Clin. Invest. |volume=37 |issue=12 |pages=1667–75 |date=December 1958 |pmid=13611033 |pmc=1062852 |doi=10.1172/JCI103758}}</ref> If it occurs together with [[Alkalosis|metabolic alkalosis]] (decreased blood acidity) it is often due to [[vomiting]].<ref name=Berend2012>{{Cite journal |last1=Berend |first1=Kenrick |last2=van Hulsteijn |first2=Leonard Hendrik |last3=Gans |first3=Rijk O. B. |date=April 2012 |title=Chloride: the queen of electrolytes? |journal=European Journal of Internal Medicine |volume=23 |issue=3 |pages=203–211 |doi=10.1016/j.ejim.2011.11.013 |issn=1879-0828 |pmid=22385875}}</ref> It is usually the result of [[hyponatremia]] or elevated bicarbonate concentration. It occurs in cystic fibrosis.<ref name=Scurati2014>{{Cite journal |last1=Scurati-Manzoni |first1=Elisabetta |last2=Fossali |first2=Emilio F. |last3=Agostoni |first3=Carlo |last4=Riva |first4=Enrica |last5=Simonetti |first5=Giacomo D. |last6=Zanolari-Calderari |first6=Maura |last7=Bianchetti |first7=Mario G. |last8=Lava |first8=Sebastiano A. G. |date=June 2014 |title=Electrolyte abnormalities in cystic fibrosis: systematic review of the literature |url=http://link.springer.com/10.1007/s00467-013-2712-4 |journal=Pediatric Nephrology |language=en |volume=29 |issue=6 |pages=1015–1023 |doi=10.1007/s00467-013-2712-4 |pmid=24326787 |issn=0931-041X|url-access=subscription }}</ref>

== Causes ==

=== Gastrointestinal causes ===

* '''Gastric fluid loss''' – loss of hydrochloric acid from the stomach due to severe [[vomiting]] or [[Gastric intubation|nasogastric suction tube]].<ref name=Berend2012/>
* '''[[Congenital chloride diarrhea]]''' – rare autosomal recessive disease characterized by persistent, lifelong, watery diarrhea with high fecal chloride concentration.<ref name="pmid1694648">{{cite journal| vauthors = Abdullah AM, Shaheed MM, Katugampola SM, Patel PJ| title = Congenital chloride diarrhoea: case report and review of the literature| journal = Annals of Tropical Paediatrics| volume = 10| issue = 1| pages = 71–4|date=March 1990| pmid = 1694648| doi = 10.1080/02724936.1990.11747412}}</ref>

=== Renal causes ===

* '''Diuretic therapy''' – [[Thiazide diuretics]] and [[loop diuretics]] like [[furosemide]] inhibit chloride reabsorption causing hypochloremia and metabolic alkalosis. Thiazides block [[Sodium-chloride symporter|NCC]] and furosemide blocks [[Na–K–Cl cotransporter|NKCC2]].<ref name=Berend2012/>
* [[Respiratory_acidosis#Chronic|'''Chronic respiratory acidosis''']] – Compensatory reabsorption of bicarbonate in exchange for chloride.<ref name=pmid13611033/><ref name=Berend2012/>
* '''[[Bartter syndrome]]''' – Chloride wasting due to defective [[Na–K–Cl cotransporter|NKCC2]] Symptoms similar to loop diuretic therapy like furosemide.<ref name=Berend2012/>
* '''[[Gitelman syndrome]]''' – Chloride wasting due to defective [[Sodium-chloride symporter|NCC]]. Symptoms similar to thiazide diuretic therapy.<ref name=Berend2012/>

=== Other causes ===

* '''[[Cystic fibrosis]]''' – Loss of chloride through excessive sweating due to defective chloride transport.<ref name=Scurati2014/>
* '''Excessive bicarbonate administration''' – Can dilute serum chloride and shift acid-base balance.<ref name=Sagar2024/>

==References==
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== External links ==
{{Medical resources
|  DiseasesDB     = 
|  ICD10          = {{ICD10|E|87|8|e|70}}
|  ICD9           = {{ICD9|276.9}}
|  ICDO           = 
|  OMIM           = 
|  MedlinePlus    = 
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{{Electrolyte abnormalities}}

[[Category:Electrolyte disturbances]]

{{Endocrine-disease-stub|}}