Chloride

Question 1

What is a major extracellular anion?

Answer 1

Chloride

-accounts for ~ 2/3 of all anion in the ECF

Question 2

What is the normal canine and feline chloride values?

Answer 2

110 -120 mEq/L

Question 3

Where does majority of Chloride get absorbed?

Answer 3

In the jejunum and colon (~90%)

Question 4

What couples with chloride during reabsorption?

Answer 4

80% of sodium

Question 5

What is the equation for corrected chloride values (in relation to Na)

Answer 5

Chloride corrected = Chloride measure x Na(normal)/Na(measured)

• Normal Na= 146mEq/L Canine. 156mEq/L Feline
• Normal Cl = 107-113 Canine. 117-123 Feline

Question 6

How do you determine artifactual from clinical chloride measurements?

Answer 6

1. Artifactual: initial chloride will be abnormal with a normal corrected chloride value
2. True corrected chloride abnormality: chloride will be abnormal after corrected chloride values have been calculated

Question 7

What electrolyte does Chloride have an inverse relationship with?

Answer 7

Bicarbonate. As chloride decreases, bicarbonate increases

Question 8

Artifactural and Pseudo-Hypochloremia

Answer 8

*Occurs when there is a change in free water
-No true electrolyte imbalance actually exist in this cases
*Parallel changes of both Na and Cl will occur
But still significant because:
*May be associated with: hypoadrenocorticism, CHF, 3rd spacing losses, GI losses(V and D)
*Artificial hypoCl are predisposed to acidosis whereas a corrected hypoCl would experience an alkalosis

Question 9

What is a strong ion difference?

Answer 9

The difference between all strong ions and all strong anions in the plasma = anion gap (AG)

• Increases in amount of strong anions = metabolic acidosis
• Kidneys regulates SID by reabsoription or secretion of Na and Cl ions in the renal tubules
• Decrease in SID leans towards acidosis
• Increase in SID leans towards alkalosis

Question 10

Artifactual HyperCl

Answer 10

• Can be due to changes in free water
• Mean chloride will be high, but corrected chloride will be normal
• Due to: disease causing free water loss
• diabetes insipidus
• hypotonic fluid loss
• osmotic diuresis
• sodium gain
• iatrogenic
• hyperadrenocorticism
• These patients have an increase in SID, hence alkalosis
• this differentiates them from a corrected hyperchloremia as the corrected on will lean towards acidosis

Question 11

Pseudohypochloremia

Answer 11

• Lipemic or hyperproteinemic samples

* Laboratory error

Question 12

Pseudohyperchloridemia

Answer 12

• Colorimetric methodologies read chloride levels higher than they are
• Hemoglobin and bilirubin pigments
• Patients on potassium bromide due to halides (iodides) in the drug being measured in chloride

Question 13

Corrected hypochloremia

Answer 13

*Alkalosis
*Excessive loss: vomiting, pyloric outflow obstruction, loop diuretic administration or thiazides, chronic respiratory acidosis, hyperadrenorcorticism, exercise, GI dz, fluid use, or sodium bicarbonate administration
in CL relative to loss of Na, or administering something containing more CL than Na

Question 14

Corrected Hyperchloremia

Answer 14

• Acidosis
• Renal dz or failure: retention of Chloride
• Excessive diarrhoea: loss of fluids with higher sodium than chloride
• DKA: kidneys excreting ketoacids instead of chloride
• DKA patients may also develop this electrolyte disturbance during resolution of DKA crisis
• Using 0.9%NaCl (with sup of KCL) =Careful when used with DKA
• Hypoadrenocorticism, chronic respiratory alkalosis, renal tubular acidosis
• TPN = iatrogenic
• Drugs: Spironolactone and acetazolamide causes retention of chloride