Hyperchloraemia

Hyperchloraemia is usually associated with sodium and inversely to HCO3

Cause of HYPERchloraemia

1. Drugs
   • Acetazolamide, aspirin OD, steroids, oestrogens
   • Thiazides, androgens
   • IV NaCl replacement
2. Metabolic
   • Respiratory alkalosis (Decreased Ca, K, Mg, increased Cl)
   • Metabolic acidosis (NAGMA)
3. Endocrine
   • Hypothalamic lesion (Increased Na) (Decreased thirst perception)
   • Adrenocortical hyperfunction
4. Renal
   1. RTA, ARF, DI
5. GIT
   1. Dehydration, prolonged diarrhoea
6. Fictitious
   1. Bromides toxicity (Bromide in serum will not be distinguished from chloride in routine testing, so intoxication may show spuriously increased chloride)

Associations

• Often associated with normal anion gap metabolic acidosis (NAGMA)
• HYPOcalcaemia
• HYPOkalaemia
• HYPOmagnesemia
• HYPERnatremia