All you need to know about hyperchloremia
Electrolytes such as chloride, sodium, and bicarbonate are minerals that dissolve in the fluids of the body.
With careful management of fluids and food, and with prompt treatment for any underlying conditions, most people can regain normal electrolyte levels.
- People with hyperchloremia have too much chloride in their bloodstream, often due to changes in the body's fluid levels.
- People undergoing chemotherapy have many risk factors for hyperchloremia.
- Treatment for hyperchloremia depends on the cause.
- It is not always possible to prevent hyperchloremia.
What is it?
Usually, high levels of chlorine in the blood is discovered during tests for electrolyte levels.
When the body is stressed, electrolyte levels may become imbalanced. The kidneys help regulate electrolyte levels, so electrolyte problems can signal a problem with the kidneys.
Hyperchloremia often points to another problem. People discover they have hyperchloremia as part of a collection of tests to measure electrolyte levels.
A doctor may order these tests if a person appears to have nutritional or fluid imbalances, kidney problems, or is undergoing chemotherapy.
Chloride helps the body maintain its fluid balance. It also helps make the digestive enzymes that help the body metabolize food. Changes in chloride levels can harm these functions.
When chloride levels are moderately high, a person may not notice any symptoms. Long-term hyperchloremia, however, can cause a range of symptoms.
- fluid retention
- high blood pressure
- muscle weakness, spasms, or twitches
- irregular heart rate
- confusion, difficulty concentrating, and personality changes
- numbness or tingling
- seizures and convulsions
The severity of symptoms depends on how high chloride levels are, how long they have remained that high, and individual factors such as:
- nutritional status
- use of various medications
The symptoms of hyperchloremia and electrolyte imbalances are so general that it is impossible to diagnose this syndrome based on symptoms alone. People should not self-diagnose.
A simple blood test can detect hyperchloremia.
Newborn infants may have hyperchloremia, without having any health problems. This is considered normal.
In newborns, hyperchloremia is normal.
A study that measured chloride levels in healthy infants, as well as preterm infants and those with health issues, found that chloride levels rose in the week following birth.
This increase was independent of whether the baby was premature or had health problems. This suggests that chloride levels naturally rise in newborns and that this rise is not due to a health problem.
Some research supports this but also suggests that babies' chloride levels are related to their chloride intake.
In children and adults, causes of hyperchloremia include:
- Gastrointestinal problems, such as vomiting or diarrhea. These issues can cause dehydration.
- A high fever that causes sweating and dehydration.
- Dehydration due to medications, intense exercise, heat exposure, or not drinking enough fluids.
- High sodium levels in the blood. Chloride tends to rise when sodium does.
- Too much salt intake. Chloride is an ingredient in sodium chloride, which is table salt.
- Diabetes insipidus, which causes the kidneys to pass large amounts of fluid.
- Diabetic coma.
- Some medications, particularly hormones, diuretics, and corticosteroids, such as hydrocortisone.
- Starvation due to eating disorders, severe malnourishment, or problems absorbing nutrients from food.
- Addison's disease, a disorder that occurs when the adrenal glands cannot produce enough hormones.
What's the relation to chemotherapy?
People undergoing chemotherapy may become nauseated or vomit, leading to dehydration that causes hyperchloremia.
Chemotherapy can also damage the kidneys, harming their ability to maintain the body's balance of electrolytes. People taking chemotherapy drugs that harm the kidneys may need regular electrolyte tests.
As chemotherapy can weaken the body, people with hyperchloremia who are undergoing chemotherapy may experience more intense symptoms.
A person should keep their doctor informed of any symptoms they experience, particularly if they suddenly get worse.
Drinking regularly, while avoiding alcohol or caffeine, may help to treat hyperchloremia.
In most cases, a diagnosis of hyperchloremia will require additional testing to uncover the cause.
Bloodwork may reveal a problem with the kidneys or liver. People should also provide their doctors with details about their diet, especially if they consume large quantities of salt.
Because some medications can alter chloride levels, it is essential that people tell their doctor about all the medicines they are taking, including herbal supplements and over-the-counter drugs.
It may be necessary to address an underlying medical condition, such as liver cirrhosis, first. People who have problems with their endocrine system — a group of glands that produce hormones — may require hormone treatments or a consultation with an endocrinologist.
Some treatment options include:
- taking medications to prevent nausea, vomiting, or diarrhea
- changing drugs if they are a factor in the electrolyte imbalance
- drinking 2–3 quarts of fluid every day
- receiving intravenous fluids
- eating a better, more balanced diet
- treating underlying mental health problems if an eating disorder is the culprit
- avoiding alcohol, caffeine, and aspirin
- gaining better control over blood glucose levels, since uncontrolled diabetes can cause electrolyte imbalances
Prompt treatment can prevent serious side effects, so people who experience symptoms of hyperchloremia should tell their doctor immediately.
Hyperchloremia can be hard to prevent, particularly when it is caused by a medical condition such as Addison's disease. For people who are at risk of developing hyperchloremia, some strategies that may help include:
- Talking to a doctor about medications that can cause hyperchloremia.
- Discussing options for reducing the effects of drugs that can cause hyperchloremia. For example, a person may need to drink more water or receive IV fluids when they feel dehydrated.
- Eating a balanced diet, and avoiding extreme food restrictions.
- Taking diabetes medications exactly as a doctor prescribes.
In otherwise healthy people, hyperchloremia is very rare. Simply drinking enough fluid and avoiding excessive salt consumption can prevent this electrolyte imbalance.
People can usually manage hyperchloremia with lifestyle changes. Individuals who notice that their symptoms are not improving or are getting worse, however, should contact their doctor immediately.
Seizures, loss of consciousness, and other serious symptoms may indicate kidney or liver failure. Hyperchloremia is a symptom, not a diagnosis. So people must discuss with their doctors the most likely cause.
For most people, treating the underlying cause of hyperchloremia can restore normal electrolyte levels. People should continue testing electrolyte levels as advised by their doctor, since sudden changes may indicate a problem.