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What Is Hypochloremia?

Medically Reviewed by Dan Brennan, MD on June 01, 2021

Hypochloremia is when you have a low level of chloride in your blood. This could be due to a wide variety of conditions.

What Is Chloride?

Chloride is an essential electrolyte. Electrolytes are minerals that are found in your blood.

These electrolytes help with:

  • Muscle function
  • Nerve function
  • Keeping the pH of your blood in the normal range
  • Maintain your balance of fluids‌

You get most of your chloride in the form of sodium chloride, or salt, in the food you eat.

Compared to the other electrolytes, there have been few research studies on chloride abnormalities. Critical care units often see abnormalities in electrolytes and pH levels, so research on chlorides has been carried out in that setting. A study found that among people in intensive care units, about 8.8% had low chloride levels.

In people who are critically ill, abnormal chloride levels are linked to more serious stages of illnesses. But the exact reason is unknown.

Symptoms of Hypochloremia

There usually aren’t any symptoms or signs of hypochloremia. But there may be associated symptoms from underlying causes of hypochloremia. 

Symptoms of electrolyte imbalance include:

  • Fever
  • Difficulty breathing
  • Confusion
  • Swelling‌

Hypochloremia often appears along with hyponatremia, which is when your blood sodium levels are low.

Causes of Hypochloremia

Because you get chloride from salt, it’s rare to be nutritionally deficient in chloride. In healthy people, chloride is usually absorbed in your gut. Then it’s transported in your blood and distributed to your tissues.

Your kidneys maintain your body’s total chloride levels. Problems with your kidneys can result in an abnormal chloride level in your body.

Hypochloremia can be caused by:

  • Diarrhea 
  • Vomiting 
  • Excessive sweating
  • Kidney problems
  • Chronic respiratory acidosis, which is when your body can’t remove all the carbon dioxide it produces
  • Syndrome of inappropriate antidiuretic hormone excretion (SIADH), when your body makes too much antidiuretic hormones. These hormones help manage the amount of water in your body. 
  • Metabolic alkalosis, which is when your body’s pH level becomes too alkaline
  • Use of certain medications like corticosteroids, diuretics, laxatives, and bicarbonates

Cancer treatment. Chemotherapy is often used to treat cancer. But chemotherapy drugs may cause an electrolyte imbalance in your body. Some side effects of chemotherapy may not show up until months or years after treatment. One of these is kidney problems, which can cause hypochloremia.

Diagnosis of Hypochloremia

Your doctor may order a chloride blood test as part of an electrolyte panel. An electrolyte panel is a blood test that measures chloride, bicarbonate, potassium, and sodium. Usually, chloride levels aren’t tested individually. 

You don’t need to fast for an electrolyte panel. A healthcare professional will take a blood sample and send it to a lab for testing. 

Sometimes your doctor may also order a urine chloride test. Urine also contains chloride. 

Regular Chloride Ranges

Your blood chloride value is a measurement of the concentration of chloride. That is, the amount of chloride in milliequivalents per liter. So hypochloremia means that your concentration of blood chloride is below the normal range.

If you have high levels of chloride in your blood, that’s known as hyperchloremia.

If you’re healthy, your blood chloride levels don’t change much during the day. But after you eat, there might be a slight drop in chloride levels because of the gastric juice produced.‌

Regular chloride ranges are:

  • Adults: 98 milliequivalents per liter to 106 milliequivalents per liter
  • Children: 90 milliequivalents per liter to 110 milliequivalents per liter
  • Newborn: 96 milliequivalents per liter to 106 milliequivalents per liter
  • Premature infant: 95 milliequivalents per liter to 110 milliequivalents per liter‌

If your chloride levels aren’t within these normal ranges, it doesn’t always mean that you have a health problem. Low chloride levels can be a result of many factors. For example, if you’ve lost fluids because you’ve been vomiting, it may affect your chloride levels. 

Treatment of Hypochloremia

Treatment of your hypochloremia depends on the underlying conditions that have caused it. Your doctor will work with you to treat your condition. When correcting your chloride levels, your doctor will base it on your health conditions.‌

You may be given an intravenous (IV) saline solution to restore your electrolyte levels.

If your electrolyte imbalance is mild, your doctor may advise you to eat foods rich in chloride or take a supplement. But check with your doctor before you take any supplements. 

All unprocessed foods have chloride at low levels. Unprocessed meat and fish may have up to 4 milligrams of chloride per gram. Vegetables and fruits generally have less than 1 milligram of chloride per gram. You can add chloride to food in the form of sodium chloride (table salt).‌

But be careful of eating too much salt. It can lead to many health issues such as:

Experts recommend the following amount of chloride:

  • Adults and children aged 11 to 17 years: 3.1 grams a day
  • Children aged 7 to 10 years: 2.6 grams a day
  • Children aged 4 to 6 years: 2 grams a day
  • Children aged 1 to 3 years: 1.7 grams a day 
WebMD Medical Reference

Sources

SOURCES: 

American Journal of Health-System Pharmacy: “Treatment of electrolyte disorders in adult patients in the intensive care unit.”

Breastcancer.org: “Electrolyte Imbalance.”

Clinical Methods: The History, Physical, and Laboratory Examinations: “Serum Chloride.”

EFSA Journal: “Dietary reference values for chloride.”

Intensive Care Medicine Experimental: “Serum chloride levels in critical illness—the hidden story.”

Journal of Pediatric and Neonatal Individualized Medicine: “Metabolic alkalosis with multiple salt unbalance: an atypical onset of cystic fibrosis in a child.”

Mayo Clinic: “Chemotherapy.”

Mayo Clinic Laboratories: “Test ID: CL Chloride, Serum.”

MedlinePlus: “Chloride Blood Test.”

Medscape: “Chloride.”

Merck Manual: “Overview of Electrolytes.”

The Scientific World Journal: “The Incidence and Prognostic Value of Hypochloremia in Critically Ill Patients.”

World Journal of Emergency Medicine: “General characteristics of patients with electrolyte imbalance admitted to emergency department.”

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