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Sample

Purpose of the test

  1. As a part of electrolytes, acid-base balance.
  2. For the diagnosis of cystic fibrosis.

Precaution

  1. Separate serum or plasma from the cells, as a change in pH, will alter the distribution of chloride.
  2. Avoid hemolysis.
  3. Serum, plasma, and urine are stable for one week at 1 to 4 °C or room temperature.
  4. A frozen sample can be kept for one year.
  5. Drugs that may increase the chloride level are ammonium chloride, acetazolamide, cortisones, androgens, and estrogens.
  6. Drugs that may decrease the chloride level are aldosterone, corticosteroids, thiazide diuretics, and loop diuretics.

Pathophysiology

  1. Chloride is the major negative electrolyte(anion) in the extracellular fluid.
    1. Plasma interstitial fluid of chloride anion is 103 mmol/L.
    2. Its concentration in intracellular fluid (RBC) is 45 to 54 mmol/L.
    3. While in the intracellular fluid of other tissue is only 1 mmol/L.
  2. Chloride ions in the food are absorbed completely in the intestine.
  3. Chloride interacts with the sodium to maintain the osmotic pressure of blood.
  4. Its main purpose is to maintain the electrical neutrality as salt with sodium.
  5. Aldosterone increases the reabsorption of sodium than chloride maintains the neutrality.
  6. Chloride acts as a buffer to help in acid-base balance.

  1. Chloride filtered at glomerulus passively and reabsorbed at proximal tubules. Further absorption at the loop of Henle.
    1. There is chloride pump in the ascending limb of the loop of Henle.
    2. Sodium is absorbed passively while Chloride is absorbed actively by the pump.
    3. Excess of the chloride is excreted in the urine and sweat.

  1. Functions :
    1. Maintenance of water balance and osmotic pressure with the help of sodium.
    2. Chloride moves into cells in exchange for bicarbonate produced in the cells.

Sign and symptoms of Hypochloremia

Sign and symptoms of Hyperchloremia

Normal

Source 1

  1. Serum = 95 to 105 meq / L (98 to 106 mmol/L)
  2. Urine = 110 to 250 meq/ 24 hours
  3. Sweat:
    1. normal = 5 to 40 meq/L
    2. marginal value =  30 to 70 meq/L
    3. cystic fibrosis = 60 to 200 meq/L
  4. CSF :
    1. Infant  = 110 to 130 meq/L
    2. Adult  =  118 to 132 meq/L
      1. These are 15% higher than those in serum.
  5. Saliva without stimulation  =  5 to 20 meq/L

Source 2

Sample  meq/L
Serum or plasma  
Cord blood 96 to 104
Premature infant 95 to 110
0 to 30 days 98 to 113
Adult 98 to 107
>90 years 98 to 111
Urine 24 hours  meq/24 hours
Infants 2 to 10
<6 years 15 to 40
Male 6 to 10 years  36 to 110 
Female 6 to 10 years 18 to 74
Male 10 to 14 years 64 to 176
Female 10 to 14 years 36 to 173
Adult  110 to 250
>60 years 95 to 195
Cerebrospinal fluid meq/L
Infant 110 to 130
Adult  118 to 132
Feces  24 hours  meq/L 
  3.2 to ± 0.7
Sweat  meq/L
 Normal  5 to 35 
 Marginal 30 to 70 
Cystic fibrosis 60 to 200
Saliva meq/L
normal without stimulation 5 to 20

Increased level(Hyperchloremia) :

  1. urinary tract obstruction, glomerulonephritis, Renal tubular acidosis, and acute renal failure.
  2. Diabetes Insipidus.
  3. Salicylate intoxication.
  4. Prolonged diarrhea with the loss of sodium bicarbonate.
  5. Respiratory alkalosis.
  6. Some cases of primary hyperparathyroidism.
  7. Maybe because of excessive intake.
  8. Eclampsia.
  9. Cushing syndrome.
  10. Renal tubular acidosis.
  11. Dehydration.
  12. Due to the excessive infusion of normal saline.
  13. Hyperventilation.

Decreased level (Hypochloremia):

  1. excessive sweating.
  2. Prolonged vomiting.
  3. Gastric suction.
  4. Salt losing nephritis.
  5. Addisonian crises.
  6. Metabolic acidosis, associated with increased organic anions.
  7. Aldosteronism.
  8. Respiratory acidosis.
  9. Water intoxication.
  10. Diuretic therapy.
  11. Hypokalemia.
  12. Burn
  13. Overhydration.

Critical values in serum or plasma are:

 


Possible References Used

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