Assessment

HISTORY. Ask the patient about factors that could cause hyperchloremia, such as severe dehydration, a recent head injury, or taking adrenal corticosteroids. Be aware that thought processes

438 Hyperchloremia may be affected, so that self-reported information may not be totally accurate. Ask about all of the patient's medications, past illnesses and surgeries, and any recent signs and symptoms that deviate from past health patterns.

PHYSICAL EXAMINATION. Physical findings depend on the source of the chloride imbalance. Assess the patient's respiratory status. If the hyperchloremia is associated with metabolic acidosis, the patient may have rapid, deep respirations. Dyspnea and pitting edema may be present with excess ECF volume. Tachycardia and hypertension may also be noted. Perform a thorough neurological assessment and note that patients may experience weakness, cognitive changes, and if the condition is severe, mental status deterioration and loss of consciousness. Since most patients who have hyperchloremia also have hypernatremia, assess for signs and symptoms that are associated with this imbalance, including restlessness, agitation, irritability, muscle twitching, hyperreflexia, and seizures.

PSYCHOSOCIAL. Assess the patient's and family's knowledge and understanding of dehydration to prevent future episodes. In the trauma patient, assess the patient's and family's ability to cope with a head injury, and assist her or him to understand the effects of head injury on fluid and electrolyte regulation. Patients on steroids often have to deal with many changes, such as fluid retention. Assess the patient's knowledge regarding steroid use.

Diagnostic Highlights

Test

Normal Result

Abnormality with Condition

Explanation

Serum chloride

95-108 mEq/L

>108 mEq/L

Reflects an excess of chloride

Serum

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