From the Research
Hyperchloremia (high chloride levels), low carbon dioxide levels, and elevated blood urea nitrogen (BUN) together suggest metabolic acidosis with possible kidney dysfunction, and patients with these findings should seek prompt medical evaluation to identify and address the underlying cause, which might include intravenous fluids for dehydration, discontinuation of offending medications, or specific treatments for kidney disorders. This combination often indicates a condition where the body's acid-base balance is disrupted, with excess acid accumulation. The hyperchloremia typically represents a normal anion gap metabolic acidosis, which can occur from conditions like diarrhea, renal tubular acidosis, or certain medications, as noted in a study published in 2020 1. Low carbon dioxide levels (measured as bicarbonate) confirm the acidotic state, as the body is trying to compensate by reducing bicarbonate. The elevated BUN suggests that kidney function may be compromised, as BUN is normally filtered and excreted by healthy kidneys.
Some possible causes of this pattern include:
- Dehydration, which concentrates blood components and stresses kidney function
- Primary kidney disease affecting acid-base regulation and waste elimination
- Certain medications that can cause metabolic acidosis
- Diarrhea or renal tubular acidosis, which can lead to hyperchloremic metabolic acidosis, as discussed in a study from 2016 2
According to a recent study from 2021 3, metabolic acidosis in chronic kidney disease can lead to poor outcomes, such as bone demineralization, muscle mass loss, and worsening of renal function, and treatment with oral bicarbonate supplementation or increased fruit and vegetable intake may help preserve kidney function. Another study from 2014 4 found that treatment of metabolic acidosis in patients with stage 3 chronic kidney disease with fruits and vegetables or oral bicarbonate reduces urine angiotensinogen and preserves glomerular filtration rate.
Overall, the management of metabolic acidosis with possible kidney dysfunction requires a comprehensive approach, including identification and treatment of the underlying cause, as well as measures to preserve kidney function and prevent further complications, as recommended in a study from 2010 5.