Hypochloremia is a condition in which you have low levels of chloride in your blood. If someone has hypochloremia, they often have hyponatremia as well, which is too little sodium (another electrolyte). These could be due to a wide variety of conditions, but the important thing about hypochloremia is what it can tell your doctor.
“Hypochloremia is basically an assessment of a patient’s volume status,” says Novia Singh, DO, a nephrologist at Mercy Medical Center in Baltimore. “Generally, people who are hypochloremic are volume depleted, not dehydrated, but volume depleted.” This means the amount of blood circulating (blood volume) throughout the body is less than it should be.
What Is Chloride?
Chloride is an electrolyte. Electrolytes are minerals, and you have many electrolytes in your body fluids, including blood.
These electrolytes help with:
- Muscle function
- Nerve function
- Keeping the pH of your blood in the normal range
- Maintaining your balance of fluids
You get most of your chloride in the form of sodium chloride, or table salt, but you also get it from the food you eat.
Compared to other electrolytes, there have been few research studies on chloride abnormalities. Critical care units (such as the intensive care unit) often see abnormal electrolyte levels, so the research available on chlorides is on seriously ill patients. One such study found that about 6.7%-37% of people in intensive care units had low chloride levels.
Abnormal chloride levels in people who are critically ill are linked to more serious stages of illnesses. That said, people who are usually healthy can still develop hypochloremia.
What Are the Symptoms of Hypochloremia?
There usually aren’t any symptoms or signs of hypochloremia. But there may be associated symptoms from underlying causes of hypochloremia.
Are hypochloremia symptoms hard to notice?
According to Singh, low chloride itself does not usually have symptoms. But if someone does have symptoms, they’re likely related to the low blood volume, which is causing the hypochloremia. The symptoms can include:
- Dizziness
- Nausea
- Vomiting
- Diarrhea
- Irregular heartbeat (arrhythmia)
- Fatigue, sleepiness
Hypochloremia often appears along with hyponatremia, which is when your blood sodium levels are low.
What Causes Hypochloremia?
Because you get chloride from salt and foods, it’s rare to be nutritionally deficient in chloride. In healthy people, chloride is usually absorbed in your gut. Then it moves in your blood and is transported and distributed to your tissues.
Your kidneys maintain your body’s total chloride levels. Problems with your kidneys can result in an abnormal chloride level in your body.
Hypochloremia can be caused by:
- Diarrhea
- Vomiting
- Excessive sweating
- Chronic respiratory acidosis, which is when your body can’t remove all the carbon dioxide it produces
- Syndrome of inappropriate antidiuretic hormone excretion (SIADH), which is when your body makes too much antidiuretic hormone (This hormone helps manage the amount of water in your body.)
- Metabolic alkalosis, which is when your body’s pH level becomes too alkaline, meaning there’s not enough acid in your blood
Can medications cause hypochloremia?
Some types of medications can cause volume depletion, such as:
- Bicarbonates
- Corticosteroids, such as prednisone
- Diuretics, such as hydrochlorothiazide (HCTZ) and Lasix
- Laxatives
Cancer Treatment
Chemotherapy is often used to treat cancer. But chemotherapy drugs, especially those that are platinum-based, may cause an electrolyte imbalance in your body. Some side effects of chemotherapy may not show up until months or years after treatment, so it’s important that any new doctors you see as a patient know your medical history. One of these delayed kidney problems could cause hypochloremia.
How Is Hypochloremia Diagnosed?
A chloride blood test is part of a routine electrolyte panel. An electrolyte panel is a blood test that measures chloride, bicarbonate, potassium, and sodium. Usually, chloride levels aren’t tested individually.
You don’t need to fast for an electrolyte panel. But if you’re having the panel done along with other blood tests, which is common, you might be told to fast for those tests. Check with the prescribing health care professional to be sure before you go for your blood draw. A nurse or phlebotomist will take some blood samples and send it to a lab for testing. Sometimes, your doctor may also order a urine chloride test. Urine also contains chloride.
What Is a Regular Chloride Range?
Your blood chloride value is a measurement of the concentration. This means it’s telling you how much chloride is in a certain amount of blood. The results come in milliequivalents per liter, or mEq/L. “Hypo” means low, so if you have hypochloremia, your concentration of blood chloride is below the normal range. “Hyper” means high, so if you have high levels of chloride in your blood, you have hyperchloremia.
If you’re healthy, your blood chloride levels don’t change much during the day. But after you eat, there might be a slight drop in chloride levels because of the gastric juice you produce to digest your food.
Are regular chloride ranges different for adults, children, and infants?
There’s a difference in the range of chloride in the blood depending on the age of the person.
Average chloride ranges are:
- Adults: 98-106 mEq/L
- Children: 90-110 mEq/L
- Newborn: 96-106 mEq/L
- Premature infant: 95-110 mEq/L
Remember, if your chloride levels aren’t within these normal ranges, it doesn’t always mean that you have a serious or long-term health problem. For example, if you’ve lost fluids because you’ve been vomiting due to a virus in you, your chloride levels may drop. As Singh points out, the level tells your doctor that you are volume depleted but not why you are volume depleted.
Treatment of Hypochloremia
Treating hypochloremia depends on the underlying conditions that caused it. Your doctor will have to diagnose the problem and treating the condition would likely correct your chloride levels.
If you’re volume depleted because of extensive vomiting and/or diarrhea, your doctor might give you intravenous (IV) saline solution. This not only gives you the fluid you need but also restores your electrolyte levels.
If your electrolyte imbalance is mild, your doctor may ask you to eat foods rich in chloride or take a supplement. But talk to your doctor before you take any supplements because they’re not all created equal, and if you take any prescription medications, there might be interactions.
All unprocessed foods have chloride at low levels. Unprocessed meat and fish may have up to 4 milligrams of chloride per gram. Vegetables and fruits generally have less than 1 milligram of chloride per gram.
Experts recommend the following amount of chloride:
- Adults and children aged 11-17: 3.1 grams a day
- Children aged 7-10: 2.6 grams a day
- Children aged 4-6: 2 grams a day
- Children aged 1-3: 1.7 grams a day
What Are the Health Risks of Consuming Too Much Salt?
You can add chloride to your diet by using table salt, but be careful and check with your doctor first before increasing your usual intake. Too much salt could lead to other health issues, such as:
- Kidney disease
- Stroke
- High blood pressure
- Heart failure
- Stomach cancer
- Osteoporosis
Takeaways
Hypochloremia is usually a sign of something else going on in your body. For some reason, your blood volume is too low or you might have a problem with your kidneys. It’s possible to develop hypochloremia if you caught a virus and you’re vomiting a lot or you have excessive diarrhea. If your chloride levels are low and you don’t have an obvious cause, your doctor will likely want to do some tests to see what might be causing it.
Hypochloremia FAQs
Why does excessive vomiting cause hypochloremia?
Excessive vomiting causes you to lose fluids, and if you can’t keep fluid loss down, you can become volume depleted.
Can vomiting, diarrhea, or excessive sweating lead to hyponatremia?
Yes, all three of those — vomiting, diarrhea, and sweating — could lead to hyponatremia if they’re excessive. The fluid loss would deplete your body fluid volume.
What happens if your body is low on chloride?
If your body is low on chloride, it can affect how your body functions overall. For example, you could have heart irregularities, muscle weakness, and even trouble breathing.