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Hyperchloremia 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za Please read this bit first The HPCSA and the Med Tech Society have confirmed that this clinical case study, plus your routine review of your EQA reports from Thistle QA, should be documented as a “Journal Club” activity. This means that you must record those attending for CEU purposes. Thistle will not issue a certificate to cover these activities, nor send out “correct” answers to the CEU questions at the end of this case study. The Thistle QA CEU No is: MTS 19/093. Each attendee should claim ONE CEU points for completing this Quality Control Journal Club exercise, and retain a copy of the relevant Thistle QA Participation Certificate as proof of registration on a Thistle QA EQA. CHEMISTRY LEGEND August 2019 Hyperchloremia Hyperchloremia is an electrolyte disturbance in which there is an elevated level of the chloride ions in the blood. The normal serum range for chloride is 98-107 mmol/L, therefore chloride levels at or above 115 - 120 mmol/L usually indicate kidney dysfunction as it is a regulator of chloride concentration. As of now there are no specific symptoms of hyperchloremia, however, it can be the influenced by multiple abnormalities that cause a loss of electrolyte-free fluid, loss of hypotonic fluid, or increased administration of sodium chloride. Cause There are many scenarios which may results in hyperchloremia. The first instance is when there is a loss of electrolyte-free fluid. This simply means that the body is losing increased amounts of fluids that do not contain electrolytes, like chloride, resulting in high concentration of these ions in the body. This loss of fluids can be due to sweating (due to exercise or fever), skin burns, lack of adequate water intake, hyper-metabolic state, and diabetes insipidus. Losing fluids can lead to feelings of dehydration and dry mucous membrane. The second scenario that may lead to hyperchloremia is known as loss of hypotonic fluid which can be a direct result of loss of electrolyte fluid. Normally, water in the body is moving from an area of low ion concentration to an area of high ion concentration. In this case, the water is being excreted in the urine, therefore, less water is available to dilute these areas of high ion concentration. This can be due to diuretic use, diarrhea, vomiting, burns, renal disease, renal failure, and renal tubular acidosis . This may also lead to feeling of dehydration. The third scenarios that may lead to hyperchloremia is an increase in sodium chloride intake. This can be due to dietary intake or intravenous fluid administration in hospital settings. This can lead to the body experiencing hypertension, edema, and cardiovascular dysfunction. Lab diagnosis Elevated levels of chloride in the blood can be tested simply by requesting a serum chloride test. A doctor would request this test if there are signs their patient is experiencing an imbalance in acid-base levels for a prolonged period of time. For the test to occur a healthcare provider must draw a sample of blood from the patient. It is preferred that blood is drawn from the vein in the inner elbow or the back of the hand. The sample will then be sent to a laboratory and results will be provided to the patient's physician. As mentioned earlier a normal serum chloride range is from 96 to 106 mEq/L, and hyperchloremic patients will have levels above this range. Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za Signs and symptoms Chloride helps the body maintain its fluid balance. It also helps make the digestive enzymes that help the body metabolize food. Changes in chloride levels can harm these functions. When chloride levels are moderately high, a person may not notice any symptoms. Long-term hyperchloremia, however, can cause a range of symptoms. Those include: a. Fluid retention b. High blood pressure c.Muscle weakness, spasms, or twitches d.Irregular heart rate e.Confusion, difficulty concentrating, and personality changes f.Numbness or tingling g.Seizures and convulsions The severity of symptoms depends on how high chloride levels are, how long they have remained that high, and individual factors such as: a.Health b.Nutritional status c.Use of various medications The symptoms of hyperchloremia and electrolyte imbalances are so general that it is impossible to diagnose this syndrome based on symptoms alone. People should not self-diagnose. Treatment As with most types of electrolyte imbalance, the treatment of high blood chloride levels is based on correcting the underlying cause. - If the patient is dehydrated, therapy consists of establishing and maintaining adequate hydration such as drinking 2-3 quarts of water daily. Also, to alleviate symptoms of dehydration like diarrhea or vomiting, it is suggested to take medication.[ - If the condition is caused or exacerbated by medications or treatments, these may be altered or discontinued, if deemed prudent - If there is underlying kidney disease (which is likely if there are other electrolyte disturbances), then the patient will be referred to a nephrologist for further care - If there is an underlying dysfunction of the endocrine or hormone system, the patient will likely be referred to an endocrinologist for further assessment - If the electrolyte imbalance is due to influx of sodium chloride in the body, then it has been suggested to make dietary changes or reduce the rate of administering intravenous fluids Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za 48 Monte Carlo Crescent Kyalami Business Park Kyalami, Johannesburg, 1684, RSA Tel: +27 (0)11 463 3260 Fax: + 27 (0)86 557 2232 Email: [email protected] www.thistle.co.za References 1. https://en.wikipedia.org/wiki/Hyperchloremia 2. https://www.medicalnewstoday.com/articles/319801.php Questions 1. What are the causes of Hyperchloremia? 2. Discuss the signs and symptoms of Hyperchloremia. 3. Discuss the treatment in patients diagnosed with Hyperchloremia. Thistle QA is a SANAS accredited organisation, No: PTS0001 Accredited to ISO guide 43 and ILAC G13 Certificate available on request or at www.sanas.co.za .
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