Hyperchloremia is an electrolyte imbalance that occurs when there’s too much chloride in the blood.
Chloride is an important electrolyte that is responsible for maintaining the acid-base (pH) balance in your body, regulating fluids, and transmitting nerve impulses. The normal range for chloride in adults is roughly between 98 and 107 milliequivalents of chloride per liter of blood (mEq/L).
Your kidneys play an important role in the regulation of chloride in your body, so an imbalance in this electrolyte may be related to a problem with these organs. It may also be caused by other conditions, like diabetes or severe dehydration, which can affect the ability of your kidneys to maintain chloride balance.
The symptoms that may indicate hyperchloremia are usually those linked to the underlying cause of the high chloride level. Often this is acidosis, in which the blood is overly acidic. These symptoms may include:
Some people may not experience any noticeable symptoms of hyperchloremia. The condition is sometimes not even noticed until a routine blood test.
Like sodium, potassium, and other electrolytes, the concentration of chloride in your body is carefully regulated by your kidneys.
The kidneys are two bean-shaped organs located just below your rib cage on both sides of your spine. They are responsible for filtering your blood and keeping its composition stable, which allows your body to function properly.
Hyperchloremia occurs when the levels of chloride in the blood become too high. There are several ways that hyperchloremia can occur. These include:
- intake of too much saline solution while in the hospital, such as during a surgery
- severe diarrhea
- chronic or acute kidney disease
- ingestion of salt water
- extremely high ingestion of dietary salt
- bromide poisoning, from bromide-containing drugs
- renal or metabolic acidosis, which happens when the kidneys don’t properly eliminate acid from the body or the body makes an excess of acid
- respiratory alkalosis, a condition that occurs when the amount of carbon dioxide in your blood is too low (such as when a person hyperventilates)
- long-term use of drugs called carbonic anhydrase inhibitors, which are used to treat glaucoma and other disorders
Hyperchloremic acidosis, or hyperchloremic metabolic acidosis, occurs when a loss of bicarbonate (alkali) tips the pH balance in your blood toward becoming too acidic (metabolic acidosis). In response, your body holds onto chloride, causing hyperchloremia. In hyperchloremic acidosis, either your body is losing too much base or retaining too much acid.
A base called sodium bicarbonate helps to keep your blood at a neutral pH. A loss of sodium bicarbonate may be caused by:
- severe diarrhea
- chronic laxative use
- proximal renal tubular acidosis, which is failure of the kidneys to reabsorb bicarbonate from urine
- long-term use of carbonic anhydrase inhibitors to treat glaucoma, such as acetazolamide
- kidney damage
The potential causes of too much acid being introduced to your blood include:
- accidental ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts (sometimes found in solutions used for intravenous feeding)
- certain types of renal tubular acidoses
- intake of too much saline solution in the hospital
Hyperchloremia is typically diagnosed by a test known as a chloride blood test. This test is usually part of a larger metabolic panel a doctor may order.
A metabolic panel measures the levels of several electrolytes in your blood, including:
- carbon dioxide or bicarbonate
Normal levels of chloride for adults are in the 98–107 mEq/L range. If your test shows a chloride level higher than 107 mEq/L, you have hyperchloremia.
In this case, your doctor may also test your urine for chloride and blood sugar levels to see if you have diabetes. A basic urinalysis can help detect problems with your kidneys. Your doctor will check the pH to see if you’re properly eliminating acids and bases.
The exact treatment for hyperchloremia will depend on its cause:
- For dehydration, treatment will include hydration.
- If you received too much saline, the supply of saline will be stopped until you recover.
- If your medications are causing the issue, your doctor might modify or stop the medication.
- For a kidney problem, you’ll likely be referred to a nephrologist, a doctor specializing in kidney health. You may need dialysis to filter your blood in place of your kidneys if your condition is severe.
- Hyperchloremic metabolic acidosis may be treated with a base called sodium bicarbonate.
If you have hyperchloremia, keep yourself well hydrated. Avoid caffeine and alcohol, as these can make dehydration worse.
An excess of chloride in your body can be very dangerous because of the link to higher than normal acid in the blood. If it isn’t treated promptly, it can lead to:
- kidney stones
- hampered ability to recover if you have kidney injuries
- kidney failure
- heart problems
- muscle problems
- bone problems
The outlook depends on what caused the hyperchloremia and how quickly it’s treated. People who don’t have kidney problems should be able to recover easily from hyperchloremia caused by receiving too much saline.
For people with hyperchloremia that stems from another illness, the outlook is typically related to that of their particular illness.