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Home :: Chloride

Chloride

This test is used to measure serum levels of chloride, the major extra cellular fluid anion. Chloride helps maintain osmotic pressure of blood and, therefore, helps regulate blood volume and arterial pressure. Chloride levels also affect acid-base balance. This mineral is absorbed from the intestines and excreted primarily by the kidneys.

Purpose

  • To detect acid-base imbalance (acidosis or alkalosis) and to aid evaluation of fluid status and extra cellular cationanion balance.

Patient preparation

  • Explain to the patient that the test is used to evaluate the chloride content of blood.
  • Tell him that the test requires a blood sample. Explain who will perform the venipuncture and when.
  • Explain that he may experience slight discomfort from the needle puncture and the tourniquet but that collecting the sample usually takes less than 3 minutes.
  • Inform him that he needn't restrict food or fluids before the test.
  • Check the patient's history for use of drugs that may increase chloride levels, such as ammonium chloride, cholestyramine, boric acid, oxyphenbutazone, phenylbutazone, and excessive LV. infusion of sodium chloride. Serum chloride levels are decreased by thiazides, furosemide, ethacrynic acid, bicarbonates, and prolonged LV. infusion of dextrose 5% in water.

Procedure and posttest care

  • Perform a venipuncture, and collect the sample in a 7-ml red-top or red­marble-top tube.
  • If a hematoma develops at the venipuncture site, apply warm soaks.
Precautions
  • Handle the sample gently to prevent hemolysis
Reference values
  • Normally, serum chloride levels range from 98 to 106 mEq/L in adults.
Abnormal findings

Chloride levels are inversely related to bicarbonate levels, reflecting acid-base balance. Excessive loss of gastric juices or other secretions containing chloride may cause hypochloremic metabolic alkalosis; excessive choride retention or ingestion may lead to hyperchloremic metabolic acidosis.

Elevated serum choride levels (hyperchloremia) may result from severe dehydration, complete renal shutdown, head injury (producing neurogenic hyperventilation), and primary aldosteronism. Low chloride levels (hypochloremia) are usually associated with low sodium and potassium levels. Possible underlying causes include prolonged vomiting, gastric suctioning, intestinal fistula, chronic renal failure, and Addison's disease. Heart failure or edema resulting in excess extracellular fluid can cause dilutional hypochloremia.

Interfering factors

  • Hemolysis due to rough handling of the sample.
  • Use of ammonium chloride, cholestyramine, boric acid, oxyphenbutazone, or phenylbutazone and excessive I.V. infusion of sodium chloride (possible increase).
  • Use of thiazide diuretics, ethacrynic acid, furosemide, or bicarbonates and prolonged I.V. infusion of dextrose 5% in water (decrease).

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