Chapter 10: Fluids and Electrolytes (Part 6)

Hypochloremia: Serum level less than

97 mEq/L

Hypochloremia: Aldosterone impacts

reabsorption

Hypochloremia: Bicarbonate has an

Inverse relationship with chloride

Hypochloremia: Chloride mainly

obtained from the diet

Hypochloremia: Pathophysiology

Addison disease, reduced chloride intake, GI loss, diabetic ketoacidosis, excessive sweating, fever, burns, medications, metabolic alkalosis

Hypochloremia: Loss of chloride occurs with

loss of other electrolytes, potassium, sodium

Hypochloremia: Clinical manifestations

agitation, irritability, weakness, hyperexcitability of muscles, dysrhythmias, seizures, coma

Hypochloremia: Important labs

ABG

Hypochloremia: Replace

chloride-IV NS or 0.45% NS

Hypochloremia: Important for management

Ammonium chloride

Hypochloremia: Monitor

I&O, ABG values and electrolyte levels

Hypochloremia: Assess for

changes in LOC

Hypochloremia: Educate about foods high in

chloride and avoid drinking free water (water without electrolytes)

high in chloride foods

tomato juice, bananas, eggs, cheese, milk

Hyperchloremia: Serum levels more than

107 mEq/L

Hyperchloremia: What happens in the body

bicarbonate loss, and metabolic acidosis can occur

Hyperchloremia: Pathophysiology

usually due to iatrogenically induced hyperchloremic metabolic acidosis

Hyperchloremia: Clinical manifestations

tachypnea; lethargy; weakness; rapid, deep respirations; hypertension; cognitive changes

Hyperchloremia: Important findings

Normal serum anion gap, Potassium Levels, ABGs, Urine Chloride Level

Hyperchloremia: Correct the underlying cause and

restore electrolyte and fluid balance

Hyperchloremia: Important management

Hypertonic IV solutions, Lactated Ringers, Sodium bicarbonate, diuretics

Hyperchloremia: Monitor

I&O, ABG

Hyperchloremia: Focused assessments of

respiratory, neurologic, and cardiac systems

Hyperchloremia: Patient teaching related to

diet and hydration

Normal plasma pH

7.35 to 7.45: hydrogen ion concentration

Maintaining Acid–Base Balance: Major extracellular fluid buffer system

bicarbonate–carbonic acid buffer system

Maintaining Acid–Base Balance: Kidneys regulate bicarbonate in

ECF

Maintaining Acid–Base Balance: Important balances

Lungs, under control of medulla, regulate CO2, and thus the carbonic acid in ECF

Maintaining Acid–Base Balance: Other buffer systems

ECF. ICF and hemoglobin

Maintaining Acid–Base Balance: ECF buffer system

inorganic phosphates, plasma proteins

Maintaining Acid–Base Balance: ICF buffer systems

proteins, organic, inorganic phosphates