Chloride is an essential element that your body needs to maintain a balance of fluids, blood volume, acid-base balance, and proper digestion. It is the second most abundant electrolyte in the body, acting as an important mineral that carries an electric charge when dissolved in a liquid like water or blood.
Chloride levels can be thrown out of balance in the body due to various factors like dehydration, kidney disease, acidosis, and excessive intake of salt or saline solutions. Abnormal levels of chloride detected in the blood can be a clue to larger issues like kidney disease, heart failure, liver disease, or high blood pressure.
Understanding the roles of chloride in the body and the potential causes of imbalances allows for a deeper understanding of health. Taking this approach allows for an understanding of the implications of elevated chloride levels and how to address them to bring the body back into balance.
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The Basics of Chloride in the Body
Chloride is the main negatively charged electrolyte (anion) in the extracellular spaces of your body, making up around 70% of the total negatively charged electrolytes in the body. This abundant element plays a key role in regulating body fluids, maintaining electrolyte balance, preserving electrical neutrality, supporting digestion as part of hydrochloric acid (HCl), and keeping acid-base status balanced.
Along with other electrolytes like sodium, potassium, bicarbonate, and magnesium, chloride helps to regulate your blood and water balance, control nerve and muscle function, and maintain acid-base balance (pH balance). It works in conjunction with other electrolytes like sodium and potassium to maintain electrochemical gradients across cellular membranes and maintain fluid balance throughout the body.
Chloride is an anion since it has a negative charge, giving it the ability to impact fluid and nutrient movement into and out of the cell across the cell membrane. Chloride channels regulate the flow of this anion across cell membranes, creating a non-equilibrium distribution that can create an electrical charge.
This also allows it to play an important role in the functioning of the nervous system. Chloride channels influence neurotransmitter functions such as GABA- and glycine-mediated synaptic inhibition, neuronal growth, sensory transduction for hearing, neurotransmitter uptake, and control of the size and volume of nerve cells. Chloride is also important for neuronal stimulation and contraction of muscle cells including the heart muscle.
Chloride channels are also found in high concentrations in the lungs, gastrointestinal system, and pancreas. As part of respiratory function, chloride is needed for red blood cells to properly exchange oxygen and carbon dioxide. It helps ensure that these blood cells take up oxygen and release carbon dioxide in the lungs and then deliver oxygen and remove carbon dioxide from other parts of the body.
In the digestive tract, chloride plays another key role as part of hydrochloric acid. Parietal cells of the stomach lining produce hydrochloric acid that is released in the gastric juices. HCl helps to create the acidic environment of the stomach to kill any ingested pathogens, start to break down proteins for digestion and convert the enzyme pepsinogen to its active pepsin form.
Understanding Blood Chloride Levels
Chloride levels can be measured in blood, sweat, urine, and feces. It can be measured on its own or is often measured as part of a comprehensive metabolic panel (CMP) or basic metabolic panel (BMP). You can also assess electrolytes like chloride with an electrolyte panel.
The typical normal range for chloride in the blood for an adult is 96 to 106 milliequivalents per liter (mEq/L) or 96 to 106 millimoles per liter although it can vary between laboratories.
When chloride levels are too low, this is known as hypochloremia. Low chloride in the blood can occur due to prolonged vomiting, diarrhea, sweating, congestive heart failure, burns, Addison’s disease, metabolic alkalosis, chronic lung disease, and hyperaldosteronism.
Elevated chloride levels, or hyperchloremia, can reflect dehydration of other conditions that impair the processing of this electrolyte. These include kidney (renal) diseases, hyperparathyroidism, and diabetes insipidus.
Causes of High Chloride Levels
Hyperchloremia occurs when chloride levels are elevated (usually over 106-110 mEq/L). While too much chloride in the blood does not automatically diagnose a specific condition it can be a clue to imbalances going on due to other conditions.
Certain health conditions can also cause elevated chloride in the blood. This can occur with metabolic acidosis when too much acid builds up in the body due to your body making too much and/or your kidneys not being about to remove enough. Elevated chloride levels may also be seen with Cushing’s syndrome, a hormonal issue where the body has chronically elevated levels of the stress hormone cortisol and in hyperparathyroidism and diabetes insipidus. Certain lung or breathing issues can also lead to elevated chloride. For example, breathing excessively (hyperventilating) over time can lead to a low level of carbon dioxide in your blood (respiratory alkalosis) which is associated with elevated chloride levels.
High chloride levels can also occur due to dehydration which can occur from too little intake prolonged diarrhea vomiting or excess sweating, too much chloride intake such as eating too much salty food, or from taking certain medications that affect how your kidneys work like diuretics.
In addition to diuretics, other medications are associated with elevated levels of chloride. These include estrogens, corticosteroids, ammonia chloride, and non-steroidal anti-inflammatories (NSAIDs).
Symptoms and Signs of High Chloride Levels
When electrolyte levels including chloride become imbalanced, dysfunction can occur in cells throughout the body. This can contribute to symptoms that reflect a disturbance in the normal acid-base and/or fluid balance of the body.
Some symptoms associated with high chloride levels and the conditions that cause this type of imbalance include repeated vomiting or diarrhea, feeling very tired and/or weak, experiencing dehydration or changes in blood pressure, and having difficulty breathing.
In the nervous system, imbalances in chloride levels within neurons contribute to seizures and epilepsy, deafness, balance issues, brain edema, pain, and neurogenic inflammation.
Diagnosing the Cause of High Chloride Levels
While most chloride (99.1%) is reabsorbed, a small amount is cleared from the body by being excreted into the urine by the kidneys. The body adjusts this amount depending on requirements and intake.
Therefore, measuring urine levels of chloride can also help determine the cause of elevated chloride levels. Normal results range from 110 to 250 mEq/24 hours for an adult. These results can be interpreted in the context of urine pH, sodium, and potassium levels to help pinpoint the cause of elevated chloride. For example, with metabolic acidosis, less sodium and potassium are excreted in the urine while urine chloride excretion stays the same or increases. Urine testing of chloride can also be used in conjunction with tests like arterial blood gasses to diagnose metabolic alkalosis and other acid-base disturbances.
Elevated levels of chloride in the urine are also seen with adrenal insufficiency, salt-losing nephropathies, increased salt intake, and increased urination (polyuria).
Kidney function testing and a urinalysis can help pinpoint specific problems with the kidneys that can contribute to elevated chloride levels. Measuring creatinine and glomerular filtration rate help assess overall kidney function. Microalbumin can also be measured in a urine collection to screen for renal disease.
Health Implications of High Chloride Levels
The health implications of elevated chloride levels depend on the underlying cause(s). It is important to thoroughly explore the underlying causes of chloride imbalances so that they can be properly addressed with a personalized treatment approach.
For example, elevated chloride levels are associated with an increased incidence of kidney damage. Although further research is needed, many studies suggest that critically ill patients often have more severe outcomes like kidney injury and complications when they are found to have elevated chloride levels. Some research also suggests that elevated blood chloride levels are associated with an increased death rate in critically ill patients, especially those receiving large amounts of intravenous sodium chloride solutions for resuscitation.
Treatment Options for High Chloride Levels
The treatment approach to high chloride levels depends on the identified underlying causative factors.
When dehydration contributes to chloride elevations, rehydration with water or infusing balanced or chloride-free electrolyte solutions can be helpful. It is also important to avoid drinking alcohol and excessive caffeine which can worsen dehydration.
Other dietary considerations include reducing added salt and processed foods in the diet.
If medications or too much saline (NaCl) solution is contributing to the issue, these medications should be assessed and adjusted by a knowledgeable professional.
If kidney issues are contributing to elevated chloride, treatment may be needed to address the underlying condition. If kidney function decreases too significantly, dialysis may be required to filter the blood in place of the kidneys.
Prevention Strategies
The amount of chloride you need to consume each day depends on many individual factors such as age, sex, life stage, and activity level. The dietary reference value (DRV) for healthy adults (over the age of 18) suggests a generally safe and adequate level of intake of around 3 grams of chloride per day.
The main source of chloride in most standard Westernized diets is table salt (NaCl) and foods that have added salt like processed meats, cheese, canned fish, and sauces. Chloride is also found naturally in all unprocessed foods in very small amounts. For example, most fruits and vegetables contain less than 1 mg of chloride per gram of food while higher concentrations of chloride are found in raw and unprocessed fish and meat which can contain up to 4 mg per gram. In comparison, a teaspoon (5 grams) of table salt (NaCl) contains around 97% of the DRV of chloride while 180 grams of raw carrots provide around 7% of the DRV.
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Key Takeaways
Chloride is an important electrolyte that helps to regulate fluid balance and acid-base status in the body. Chloride can be monitored using blood or urine testing that is often done as part of a comprehensive or basic metabolic profile. Levels of chloride above 95-106 mEq or 96 to 106 millimoles per liter in the blood are considered high (hyperchloremia).
Elevated chloride levels can help bring attention to other potential underlying health issues like kidney disease or metabolic acidosis. They can also occur due to certain medications.
It is important to pay attention to electrolyte balance and symptoms as part of a comprehensive assessment. This allows for early recognition of imbalances and personalized treatment approaches to bring the body back into balance.
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