Chloride

Question 1

What are the 2 primary regulators of chloride balance ?

Answer 1

1- GI system :
* Electro-neutral abs° with Na+
* Cl- secretion (driving fluid secretion)
2- Renal system

Question 2

What is the pseudohypochloremia ?

Answer 2

Hyperlipemia may falsely lowered value of Cl-

Question 3

Causes of hypochloremia ?

Answer 3

1- Increase loss of Cl- :
* renal losses (renal failure, diuresis, diuretics, acid-base abnormality)
* GI losses (reflux, diarrhea)
* sweat (prolonged exercise, hot climates)
2- Decrease intake of Cl- : minor impact of anorexia
3- Dilution effect : same effect on Na+ and Cl-
4- Hyperlipemia

Question 4

How to evaluate a dilutional effect ?

Answer 4

As dilutional effect has a similar effect on Na+/Cl- :
If hypoNa+ = dilutional effect, evaluate for free water expansion of ECFV
If normal Na+ = evaluate for increase losses of Cl-

Question 5

What are the clinical effects of hypochloremia ?

Answer 5

Unlikely to be clinically relevant. Often an important sign of ongoing acid-base or metabolic abnormalities, compensation for acidosis (correction unnecessary)

Question 6

What is hypochloremia a marker of?

Answer 6

Often an important sign of ongoing acid-base or metabolic abnormalities, compensation for acidosis (correction unnecessary)

Question 7

When and how to treat hypochloremia ?

Answer 7

• If hypochloremia + metabolic alkalosis : consider TT with high chloride IV fluid (0,9% NaCl)
• If no metabolic alkalosis : consider if TT is needed

Question 8

Causes of hyperchloremia ?

Answer 8

1- Retention of Cl- :
* Renal tubular acidosis (RTA) = hyperchloremic metabolic acidosis → depression, anorexia. Type I = distal tubular dysf° and failure to excrete H+. Type II = proximal tubular dysf° and failure to reabsorb bicarbonate.
* Respiratory alkalosis = normal renal retention of Cl- (no TT)

2- Increase Cl- intake : diet with low DCAB (dietary cation-anion balance), IV fluids, parenteral nutrition

3- Contraction effect : decrease ECFV, no access to free water

Question 9

Clinical effects of hyperchloremia ?

Answer 9

Unlikely to be the sole cause of clinical signs. Hyperchloremic acidosis → depression, anorexia, mild colic, increased RR

Question 10

When and how to treat hyperchloremia ?

Answer 10

1- Evaluate [Na+] for contraction effect
If hyperNa+ → evaluate for causes of free water contraction of ECFV
If normal Na+ → evaluate for retention of Cl- (renal, medication, diet, GI)
2- Evaluate the acid-base status
If mild acidemia → evaluate the underlying causes
If severe acidemia (pH< 7,2) → sodium bicarbonate IV or PO

Question 11

What is the common cause of hyperchloremia in foals ?

Answer 11

Parenteral nutrition (as urinary FE of Cl- is lower in foals)

Question 12

DDX of synchronous diaphragmatic flutter

Answer 12

• Hypocalcemia
• Hypochloremic metabolic alkalosis
• Hypokalemia