Discharge And Home Healthcare Guidelines

Encourage ambulation and a fluid intake of 3 to 4 L of fluid per day, including acid-ash juices (e.g., cranberry juice). Explain the importance of avoiding excessive amounts of calcium-rich foods and calcium-containing medications. Caution the patient against taking large doses of vitamin D. Be sure the patient understands any medication prescribed, including dosage, route, action, and side effects. Remind the patient to report to the physician the appearance of any symptoms of flank pain, hematuria, palpitations, or irregular pulse.

Serum chloride excess, hyperchloremia, occurs when the serum chloride level is greater than 108 mEq/L. Normal serum chloride level is 95 to 108 mEq/L. Chloride is the major anion in extracellular fluid (ECF). Chloride is regulated in the body primarily through its relationship with sodium. Serum levels of both sodium and chloride often parallel each other.

Chloride performs a number of essential physiological functions. One is to join with hydrogen to form hydrochloric acid (HCl), which aids in digestion and activates enzymes, such as salivary amylase. Chloride also plays a role in maintaining the serum osmolarity and the body's water balance. The normal serum osmolarity ranges from 280 to 295 mOsm/L. Hyperchloremia, like hypernatremia, causes an increase in the serum osmolarity (the proportion of sodium and chloride ions to water in the ECF). Chloride influences the acid-base balance as well. To maintain acid-base balance, the kidneys excrete chloride or bicarbonate. Each sodium ion that is reabsorbed in the renal tubules reabsorbs either a chloride or a bicarbonate ion, depending on the acid-base balance of the ECF. In metabolic acidosis, the kidney excretes chloride in exchange for bicarbonate.

The most common cause of hyperchloremia is body fluid loss, or dehydration, which leads to renal retention of water. Other causes are changes in hormones, trauma, and acid-base imbalances (hyperchloremic acidosis). Excessive levels of adrenal cortical hormones can cause excess sodium levels, and thereby chloride, in the body. In head-injured patients, sodium is frequently retained and thus chloride is also retained. In addition, hyperchloremia can be caused by any condition that allows for excessive chloride intake or absorption.

Hyperchloremia may result as a feature of genetic disease resulting in electrolyte imbalances.

Infants, young children, and elderly people of both sexes are at particular risk since they are prone to dehydration. There are no known racial or ethnic considerations.


DRG Category: 296

Mean LOS: 5.4 days

Description: MEDICAL: Nutritional and

Miscellaneous Metabolic Disorders, Age > 17 without CC

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