Hypochloremia: Pathophysiology, Symptoms, Causes and Treatment

What is it? It is an imbalance in the electrolytes, where there is abnormal exhaustion of chlorine ions in the blood.

The average value ranges from 97-107 mEq / L. However, in hypochloremia, chloride levels become less than 98mEq / L. It is often associated with hypokalemia, hyponatremia, and metabolic acidosis.

Chloride is the primary anion found in the fluid outside the cells and blood.

An anion is the negatively charged part of certain substances such as table salt (NaCl) when dissolved in liquid. Seawater has almost the same concentration of chloride ions as human fluids.

The rest of the chloride ion (Cl-) is tightly regulated by the body. Significant decreases in chloride can have detrimental or even fatal consequences.

Chloride is usually lost in the urine, sweat, and stomach secretions.

Excessive loss can occur from sweating, vomiting, adrenal gland, and kidney disease.


Aspects to take into account

Chloride is the primary anion observed in both blood and extracellular fluid. According to The Vitamins and Nutrition Center, chloride, potassium, and calcium are the most crucial serum electrolytes.

The anion is nothing, but the negatively charged part of some substances, such as sodium chloride (NaCl) or table salt, to dissolve in liquid.

There is a maximum of chloride ions in the food we eat. Average values ​​increase as we consume more canned foods rich in salt.

Sodium chloride in the blood

  • It helps maintain the acid-base balance in the body.
  • Seawater and human liquids have the same concentration of chloride ions.
  • The balance of the chloride ion is regulated and maintained by the body. Any significant decrease or increase can have harmful or fatal consequences.
  • During digestion, the intestines absorb chloride.
  • Excess chloride after the digestion process is excreted in the urine.
  • The kidneys control the levels of chloride in the blood.

The abnormal elevation of chloride can be found in diarrhea, hyperparathyroidism, and kidney diseases.

The chloride binds with hydrogen to form HCl (hydrochloric acid).

Hypochloremia: Physiopathology

Due to volume depletion, the chloride level decreases. Therefore, the kidneys retain the bicarbonate and sodium ions to balance the incurred loss.

As a result, bicarbonate accumulates in the ECF, thereby raising the pH level that leads to hypochloremic metabolic alkalosis.

Physiological alterations

  • Contraction of volume ECF.
  • Intracellular acidosis
  • Depletion of potassium
  • Increase in bicarbonate production.
  • Decrease in serum osmolarity.


  • Metabolic alkalosis
  • Diarrhea.
  • Threw up.
  • Loss of respiratory capacity.
  • Gastric aspiration (NG suction).
  • Hyponatremia
  • Adrenal insufficiency (Addison’s disease).
  • Renal insufficiency.
  • Edematous states – congestive heart failure.
  • Pseudohiponatremia.
  • Nephritis.
  • Excessive intravenous fluids during hospitalization.
  • Excessive sweating
  • Burns.
  • Other causes
  • Changes in diet (low sodium diet).


  • Loop and Thiazide Diuretics.
  • Aldosterone
  • ACTH.
  • Corticosteroids
  • Bicarbonates
  • Laxatives
  • Genetic diseases.
  • Cystic fibrosis.

Bartter’s syndrome (is a group of several disorders due to the reabsorption of damaged salt in the thick loop of ascending Henle).

Symptoms of Hypochloremia

  • Excess fluid loss or dehydration (diarrhea, vomiting).
  • Low levels of serum chloride
  • Muscle hypertension (spasticity).
  • Spanish.
  • Depressed superficial respiration.
  • Hyponatremia
  • Muscular weakness.
  • Muscle spasms.
  • Perspiration.
  • High fever.


Like other electrolyte imbalances, treating high blood chloride levels or hypochloremia is correcting the underlying cause. It includes the following reasons:

  • For dehydration:

Establish and maintain adequate hydration.

  • For pharmacological treatment in particular:

Alter or discontinue medications (especially lazotiazides)

  • For kidney disease:

Consult a nephrologist.

  • For hormonal or endocrine causes:

Consult an endocrinologist.

Electrolyte replacement therapy

Intravenous administration of standard saline solution (sodium chloride 0.9) or saline solution (sodium chloride 0.45).

Ammonium chloride (an acidifying agent) – This is to treat metabolic alkalosis. The dose depends on the level of serum chloride and the patient’s weight. This is contraindicated in cases of impaired renal or hepatic function.

Oral or intravenous KCl (10-40 mEq PO). IV must not exceed 20 mEq / h.

Dietary modifications

Eat a diet rich in sodium and potassium since hypochloremia causes deficiency of these nutrients.

When should you call your doctor?

  • In cases of extreme nausea that interfere with feeding and are not relieved by medications.
  • Vomit more than 4 to 5 times a day.
  • Diarrhea – 4 to 6 episodes in a day, and not reduced by modification of diet or antidiarrheal medications.
  • Severe constipation for 2 to 3 days and not relieved by laxatives.
  • Irritability and muscle spasms.
  • Lack of appetite and increased urination.
  • Drowsiness or excessive confusion.

Prevention of Hypochloremia

The chloride present in the diet we consume is the most common source of minerals and can help maintain the level of chloride in the blood within normal limits.

According to the National Institute of Health, adults should consume 2 to 2.3 g of chloride/day. This need decreases as age advances and increases during pregnancy and lactation.

Some foods include tomatoes and tomato juice, olives, celery, lettuce, etc. They are high in chloride. Therefore, this must be consumed during exhausted chloride ion levels.

The most common cause of hypochloremia is gastrointestinal (GI) abnormalities, including prolonged vomiting, nasogastric suction, loss of potassium, and diarrhea.

The loss of potassium, which occurs due to gastric suction and vomiting, also leads to hypochloremia because potassium is often combined with chloride to form potassium chloride (KCl).

Chloride is also lost through diarrhea, which has a high chloride content.

Other hypochloremia causes are diet changes, renal abnormalities, acid-base imbalances (particularly respiratory acidosis and metabolic alkalosis), and skin loss.

Low-sodium diets can contribute to hypochloremia, as can drugs such as thiazides and loop diuretics.

Another common cause in hospitalized patients is stopping all oral intake during disease and placing patients in the intravenous fluid.