Hypochloremia Lecture Notes

Overview

• Hypochloremia: Low chloride in the blood (chloride < 97 mEq/L)
• Chloride's main functions: Maintain blood volume, blood pressure, pH balance (with sodium)
• Chloride regulation: Closely linked to sodium (follows sodium)

Causes of Hypochloremia (CHAMP)

• C: Chloride lost from fluids
  • Examples: Vomiting, diarrhea, NG tube suctioning, sweating, fevers, burns
• H: Hyponatremia
  • Low sodium levels
• A: Addison's Disease and Adrenal Crisis
  • Causes hyponatremia (low sodium, leading to low chloride)
• M: Medications
  • Diuretics (increase excretion of chloride, sodium, potassium)
• P: pH Imbalances
  • Metabolic alkalosis (e.g., fluid loss from vomiting)

Signs and Symptoms of Hypochloremia

• Similar to hyponatremia (low sodium)
• Cardiovascular
  • Depressed, deflated heart, hypotension (low blood pressure)
  • Dysrhythmias (EKG changes)
• Respiratory
  • Depressed, deflated lungs and diaphragm
  • Dyspnea (difficulty breathing), shortness of breath, ineffective respiratory movement
• Neurological
  • Depressed, deflated brain
  • Irritability, seizures, comas, confusion
• Gastrointestinal (GI) & Genitourinary (GU)
  • Depressed, deflated intestines and urinary tract
  • Diarrhea, nausea, vomiting
• Musculoskeletal
  • Depressed, deflated muscles
  • Tremors, muscle cramps

Nursing Interventions

• Add salt (chloride follows sodium)
  • IV normal saline or half NS (0.45% normal saline)
• Teach patients to avoid free water
  • Can cause hemodilution (low, liquidy lab values)