Hyperchloremic acidosis

Hyperchloremic acidosis
Hyperchloremic acidosis
Specialty	Endocrinology, nephrology

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and an increase in plasma chloride concentration (see anion gap for a fuller explanation). Although plasma anion gap is normal, this condition is often associated with an increased urine anion gap, due to the kidney's inability to secrete ammonia.^{[citation needed]}

Causes

In general, the cause of a hyperchloremic metabolic acidosis is a loss of base, either a gastrointestinal loss or a renal loss^{[citation needed]}.

Gastrointestinal loss of bicarbonate (HCO⁻
₃) ^{[citation needed]}
- Severe diarrhea (vomiting will tend to cause hypochloraemic alkalosis)
- Pancreatic fistula with loss of bicarbonate rich pancreatic fluid
- Nasojejunal tube losses in the context of small bowel obstruction and loss of alkaline proximal small bowel secretions
- Chronic laxative abuse
Renal causes^{[citation needed]}
- Proximal renal tubular acidosis with failure of HCO⁻
  ₃ resorption
- Distal renal tubular acidosis with failure of H⁺
  secretion
- Long-term use of a carbonic anhydrase inhibitor such as acetazolamide
Other causes^{[citation needed]}
- Ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts
- The treatment and recovery phases of diabetic ketoacidosis
- Volume resuscitation with 0.9% normal saline provides a chloride load, so that infusing more than 3–4L can cause acidosis
- Hyperalimentation (i.e., total parenteral nutrition)