CHLORIDE
IMBALANCES
HYPOCHLOREMIA
Chloride loss (Vomiting, Acute/Chronic renal
Insufficient Chloride diet Diuretics failure
diarrhea & sweating)
Chemical breakdown of Lower reabsorption of Decline in renal
Loss of Cl- in the ECF
Chloride containing food chloride in the kidney function
No equilibrium between Less chloride
Production HCL Excess Excretion Chloride Decrease in Glomerular
ECF &ICF absorption in the
in the urine filtration rate
intestines
Fluids shift out from No equilibrium between Cells in the stomach lining Decrease in chloride
Intravascular Space ECF &ICF secretes Hydrochloric Acid due to volume depletion
Intravascular Fluid Production Of
Fluid Imbalance NA+ & bicarbonate
Deficit Hydrochloric Acid retention in the kidney
Bicarbonate
Blood Blood accumulates in ECF
pressure volume Decrease in sodium parallel
to low levels of chloride
PH level elevated
beyond normal range
Na+ levels lower than
normal range
Metabolic
Hyponatremia
Alkalosis
HYPERCHLOREMIA
Predisposing
Factors
Excess intake of
chloride (I.V.F, NGT) • Age
Diuretics
• Body Size
Increase of Cl- in the Water Excreted in the
• Environmental
GIT urine
Temperature
Excess Chloride Increase chloride Less water to dilute high
absorption in the
concentration of chloride
intestines
Chloride retention Increase in sodium parallel No equilibrium between
in the kidney to high levels of chloride ECF &ICF
Excess retention of
chloride in the kidney
Loss of bicarbonate
ions Na+ levels higher than
Fluid Imbalance
normal range High level of Cl- in ECF
No Bicarbonate in ECF
Excess water due to
Hypernatremia increased intake of
chloride
PH level decreases
beyond normal range
Metabolic Edema
Acidosis Hypovolemia
CNS Cardiovascular GIT Muscular CNS Cardiovascular GIT
• Intracranial • Diarrhea
• Lethargy • Diarrhea • Tremors
pressure • Cardiac
• Confusion • Dysrhythmias • Nausea • Muscle
• Seizures dysrhythmias
• Headaches • Hypotension • Vomiting cramp
• Coma • Hypertension
• Seizures • Hypovolemia • Tetany
• Hypervolemia
• Tachycardia
Urinary Vital signs Urinary Vital signs
Muscular
• Renal • Weakness • Diuresis • BP
Failure • BP • Dehydration
• Fatigue
Laboratory and Diagnostic tests
• Chloride urine test collected over a 24-hour period
• Arterial blood gas analysis- identifies the acid–base imbalance
• A metabolic panel measures the levels of several electrolytes in
your blood, including:
carbon dioxide or bicarbonate
chloride
potassium
sodium
Medical Medical
Management Management
(Hypochloremia) (Hyperchloremia)
• Normal saline or • Lactated Ringer’s
half-strength saline solution may be
solution is prescribed to
administered IV to convert lactate to
replace the chloride. bicar-bonate in the
liver, which will
• Diuretics(loop, increase the base
osmotic, or thiazide) bicarbonate leve
land correct the
• Foods high in acidosis.
chloride are
provided; these • Sodium bicarbonate
include tomato juice, may be given IV to
salty broth, canned increase bicarbonate
vegetables, levels, which leads to
processed meats, the renal excretion of
and fruits. chloride ions as
bicarbonate and
chloride compete for
• Ammonium chloride, combination with
an acidifying agent, sodium.
may be prescribed to
treat metabolic • Diuretics
alkalosis
Nursing Intervention Rationale Nursing Intervention Rationale
• monitors intake and • To identify if • Monitors intake and • To know patients
output. there are fluid output. and the
imbalances. effectiveness of
• Monitors Arterial blood the treatment.
• Monitors Arterial blood • To identify Acid- gas values
gas values base imbalances.
• Vital signs are
• Monitors serum • Identify monitored
electrolyte levels Electrolyte • Identifies
imbalances. • Respiratory assessment changes and must
be reported to
• Assess the patient’s • May indicate • Neurologic assessment physician
level of consciousness comatose.
• Cardiac Assessment
• Vital signs are • Baseline Data. • Sodium, fluids,
monitored • Teaches the patient and chloride
about the diet that intake are
• Respiratory assessment • Identify Problems should be followed to restricted .
in the Respiratory manage hyperchloremia
system.
• Teaches the patient • For client to know
about foods with high what foods gives
chloride content chloride.
• Assess muscle strength • To identify if
there are
muscular
problems
