Hyperchloraemia
April 24th, 2019
Overview
Hyperchloraemia rarely exists on its own, and is usually found in the presence of hypernatraemia (due to water loss or salt gain) or normal anion gap (hyperchloraemic) metabolic acidosis. Hyperchloraemia can also occur in the setting of renal compensation for respiratory alkalosis.
Aetiology
Causes of Hyperchloraemia
Water Loss
- Inadequate water intake
- Diabetes insipidus (neurogenic / nephrogenic)
- Loop diuretics
- Acute tubular necrosis (polyuric phase)
- Osmotic diuresis (e.g. poorly controlled diabetes)
- Non-urinary loss - insensible, sweat, burns, diarrhoea
Salt Gain
- Excessive administration - dietary excess, hypertonic saline, hypertonic dialysis
- Hyperaldosteronism
- Cushings
Hyperchloraemic Metabolic Acidosis
- GI loss - diarrhoea, fistula, stoma
- Isotonic saline infusion
- Renal tubular acidosis
- Acetazolamide
- Addison's disease
Compensation for Respiratory Alkalosis
- Hyperventilation - hypoxia, anxiety, pain, intracranial pathology, pregnancy
Approach
Determine whether the patient is hypernatraemic or has an acid-base abnormality, and then investigate further depending on the result.
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