What is the significance of a serum creatinine level of 0.58 milligrams per deciliter (mg/dL) and a chloride level of 93 milliequivalents per liter (mEq/L)?

From the Guidelines

The creatinine level of 0.58 mg/dL is within normal range, indicating normal kidney function, and the chloride level of 93 mEq/L is slightly below the normal range, suggesting mild hypochloremia, which is generally not concerning on its own but should be monitored, as per the guidelines from the Kidney Disease: Improving Global Outcomes organization 1.

Normal Kidney Function

The creatinine level is typically used to assess kidney function, and a level of 0.58 mg/dL is considered within the normal range for both men and women, suggesting that the kidneys are functioning properly.

• Normal creatinine levels typically range from 0.6-1.2 mg/dL for men and 0.5-1.1 mg/dL for women.
• The provided creatinine level does not indicate any acute kidney injury (AKI) as defined by the increase in serum creatinine by 0.3 mg/dL within 48 hours or an increase in serum creatinine to 1.5-fold from baseline, according to the Kidney Disease: Improving Global Outcomes organization clinical practice guidelines 1.

Mild Hypochloremia

The chloride level of 93 mEq/L is slightly below the normal range, which typically ranges from 96-106 mEq/L, indicating mild hypochloremia.

• Hypochloremia can occur due to various conditions, including vomiting, diarrhea, certain medications (like diuretics), or metabolic alkalosis.
• Mild hypochloremia is generally not concerning on its own but should be monitored, especially if accompanied by other symptoms such as weakness, fatigue, or difficulty breathing.

Monitoring and Management

It is essential to interpret these values in the context of other laboratory findings and the patient's clinical condition.

• Increasing salt intake moderately through diet may help normalize chloride levels, but this should only be done under medical supervision.
• Drinking adequate fluids is also important to maintain electrolyte balance.
• The guidelines for the evaluation and management of acute kidney injury in patients with cirrhosis, as outlined in the AGA clinical practice update, should be considered in the management of patients with abnormal kidney function 1.

From the Research

Electrolyte and Acid-Base Balance

• The kidneys play a crucial role in regulating electrolyte and acid-base balance in the body 2, 3.
• Derangements in electrolytes and acid-base balance can occur with progressive loss of kidney function, contributing to poor patient outcomes 2.

Creatinine Levels

• A serum creatinine level of 0.58 is considered low to normal, depending on the laboratory reference range and individual factors such as age, sex, and body size 4.
• Elevated serum creatinine levels can indicate kidney dysfunction or disease, and earlier referral to a nephrologist is recommended for patients with elevated creatinine levels 5.

Chloride Levels

• A chloride level of 93 is within the normal range, which typically ranges from 96 to 106 mmol/L, but can vary slightly depending on the laboratory reference range 3.
• Electrolyte imbalances, including abnormalities in chloride levels, can occur in patients with kidney disease or other conditions affecting acid-base balance 2, 3.

Clinical Implications

• Patients with abnormal electrolyte or acid-base levels, including those with kidney disease, require timely and appropriate management to prevent complications and improve outcomes 2, 5, 3.
• Healthcare providers should be aware of the potential for electrolyte and acid-base derangements in patients with kidney disease and take steps to prevent, diagnose, and treat these conditions 2, 3.