Hypochloremic

Hypochloremic refers to a condition in which there is a lower-than-normal concentration of chloride in the blood, typically measured as serum chloride below the lower limit of the reference range used by a laboratory (often around 98 to 106 mEq/L, depending on the assay). The term can describe the electrolyte imbalance itself or a state associated with low chloride.

Chloride is the major extracellular anion and works with sodium, bicarbonate, and other ions to maintain osmotic balance, acid-base status, and electrical neutrality. Hypochloremia commonly occurs in conjunction with metabolic alkalosis, because loss of chloride limits the kidney’s ability to excrete bicarbonate, helping sustain an elevated pH. It can also accompany volume depletion and renal salt wasting.

Common causes include gastrointestinal losses such as prolonged vomiting or gastric suctioning, which remove hydrochloric acid; renal losses from diuretic therapy or certain kidney disorders; and excessive sweating with substantial chloride loss. Less frequent causes include hormonal or endocrine disorders and conditions that provoke persistent bicarbonate retention with concomitant chloride depletion.

Clinical features are often related to the underlying disorder and the acid-base status rather than chloride alone. Symptoms may include fatigue, weakness, confusion, dehydration, or neuromuscular irritability in severe cases. Diagnosis relies on a chemistry panel and arterial blood gas to assess chloride alongside bicarbonate, sodium, and potassium; evaluation should consider the patient’s volume status and rate of loss.

Management focuses on treating the underlying cause and restoring chloride and volume. This typically involves isotonic saline and, if needed, potassium correction; monitoring of electrolytes guides ongoing therapy and prevention of recurrence.