HISTORY. Ask about any recent signs and symptoms that deviate from past health patterns that could cause hypochloremia, such as vomiting and diarrhea. Ask the patient to list all medications, especially diuretics, which contribute to chloride loss. Obtain a history of past illnesses and surgeries. If the patient is already hospitalized, review the records for prolonged dextrose administration and a history of gastric suctioning.

PHYSICAL EXAMINATION. Physical findings depend on the cause of the chloride deficit. Inspect the patient for tetany-like symptoms, such as tremors and twitching; these neuromus-cular symptoms are present with hypochloremia associated with hyponatremia. If hypochloremia is caused by metabolic alkalosis secondary to the loss of gastric secretions, respiratory and neuromuscular symptoms appear. Assess the patient's respirations and note the depth and rate; the patient's breathing may become shallow and depressed with severe hypochloremia. If the chloride deficit is not corrected, eventually a decrease in blood pressure occurs.

PSYCHOSOCIAL. In most cases, hypochloremia is a result of GI abnormalities. Assess the patient's tolerance and coping ability to handle the discomfort. If the patient is upset about changes in nerves and muscles, explain that the symptoms disappear when chloride is supplemented.

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