Hypochloremia - Differential Diagnosis Algorithm Cause - Decreased Intake: • Low salt in diet • Exclusive D5W use • Water intoxication Cause - Increased Loss: • GI LOSS: - Excessive vomiting - Metabolic alkalosis - Fistulas - Ileostomy - NGT suction - Diarrhea • RENAL LOSS: - Diuresis - Bartter - Gitelman SIGNS: • Muscle weakness • Hypotension • AMS (altered mental status) • Tachycardia • Fatigue Chloride is essential for blood pressure control, decarboxylation/gas transport, renal function, and gastrointestinal homeostasis. • Blood pressure: - Cl⁻ increases blood pressure - Cl⁻ is inversely related to renin secretion - Cl⁻ influences smooth muscle cells • Gas exchange: - Transcellular shifting of Cl⁻ facilitates oxygen unloading • Kidney: - Cl⁻ is inversely related to glomerular filtration rate by tubulo-glomerular feedback mechanism • Gastrointestinal function - Cl⁻ is the major contributor to stomach acidity - Cl⁻ is responsible for maintenance of the gastrointestinal osmotic gradient and fluid secretion • Acid-base equilibrium - Cl⁻ is the major extracellular anion - Interplay of Cl⁻ with other components of acid-base homeostasis is complex - Cl⁻ increase may cause metabolic acidosis - Cl⁻ decrease may cause metabolic alkalosis #Hypochloremia #Differential #Diagnosis #Algorithm #Pathophysiology #Nephrology #Chloride
