From the Guidelines
Hyperchloremia, or elevated chloride levels, is a serious electrolyte imbalance that can lead to increased morbidity and mortality, particularly in perioperative patients, and should be managed with caution to prevent complications such as hyperchloremic acidosis, renal vasoconstriction, and acute kidney injury. High chloride levels on labs, known as hyperchloremia, typically indicate an electrolyte imbalance in the body. Normal chloride levels range from 96 to 106 mEq/L, and values above this range are considered elevated. Hyperchloremia often occurs alongside other electrolyte disturbances and may result from several conditions including dehydration, kidney dysfunction, certain medications (like some diuretics or IV fluids containing high chloride), or metabolic acidosis.
Causes and Symptoms
- Dehydration
- Kidney dysfunction
- Certain medications (like some diuretics or IV fluids containing high chloride)
- Metabolic acidosis Symptoms are usually related to the underlying cause rather than the high chloride itself, but may include weakness, confusion, or breathing difficulties in severe cases.
Treatment and Management
Treatment focuses on addressing the underlying cause, which might involve fluid management, medication adjustments, or treating kidney issues. According to the most recent study 1, buffered intravenous solutions are recommended in the perioperative period to prevent hyperchloremic acidosis and other complications. If you have high chloride levels, your healthcare provider will likely perform additional tests to determine the cause and develop an appropriate treatment plan. Chloride plays an important role in maintaining acid-base balance, fluid balance, and proper nerve and muscle function in the body, which is why maintaining normal levels is important for overall health.
Key Considerations
- Avoiding excessive use of 0.9% saline, which can cause hyperchloremic acidosis and other complications 1
- Using buffered crystalloids instead of 0.9% saline to reduce the risk of major adverse kidney events (MAKE) 1
- Monitoring patients closely for signs of hyperchloremia and other electrolyte imbalances, particularly in the perioperative period 1
From the FDA Drug Label
OVERDOSAGE: Administration of too much sodium chloride may result in serious electrolyte disturbances with resulting retention of water, edema, loss of potassium and aggravation of an existing acidosis. PRECAUTIONS: General Excessive amounts of sodium chloride by any route may cause hypopotassemia and acidosis.
Hyperchloremia refers to an elevated level of chloride in the blood. This can occur when there is an excessive intake of sodium chloride. The consequences of hyperchloremia may include: