View source for Hyperchloremic acidosis

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'''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<ref>{{Cite journal|date=2017-10-19|title=Hyperchloremic Acidosis: Practice Essentials, Etiology, Patient Education|url=https://emedicine.medscape.com/article/240809-overview}}</ref> (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]].{{cn|date=November 2024}}

==Causes==
In general, the cause of a hyperchloremic metabolic acidosis is a ''loss of base'', either a gastrointestinal loss or a renal loss{{cn|date=November 2024}}. 

*[[Gastrointestinal]] loss of bicarbonate ({{Chem|HCO|3|-}}) {{cn|date=November 2024}}
** 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{{cn|date=November 2024}}
** Proximal [[renal tubular acidosis]] with failure of {{Chem|HCO|3|-}} resorption 
** Distal renal tubular acidosis with failure of {{Chem|H||+}} secretion
** Long-term use of a [[carbonic anhydrase inhibitor]] such as [[acetazolamide]]
*Other causes{{cn|date=November 2024}}
** 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]])

==See also==
*[[Anion gap]]
*[[Metabolic acidosis]]
*[[Pseudohypoaldosteronism]]

==References==
{{reflist}}

==Further reading==
* {{cite journal |author=Kellum JA |title=Fluid resuscitation and hyperchloremic acidosis in experimental sepsis: improved short-term survival and acid-base balance with Hextend compared with saline |journal=Crit. Care Med. |volume=30 |issue=2 |pages=300–5 |date=February 2002 |pmid=11889298 |doi= 10.1097/00003246-200202000-00006|s2cid=24375350 }}
== External links ==
{{Medical resources
|   ICD10          = {{ICD10|E|87|2|e|70}} 
|   ICD9           = {{ICD9|276.2}} 
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|   eMedicineSubj  = med
|   eMedicineTopic = 1071 
}}
* {{DiseasesDB|11673}}
* [https://web.archive.org/web/20110728025351/http://kidney.niddk.nih.gov/kudiseases/pubs/tubularacidosis/ NIH – Renal Tubular Acidosis]

{{Water-electrolyte imbalance and acid-base imbalance}}

{{DEFAULTSORT:Hyperchloremic Acidosis}}
[[Category:Acid–base disturbances]]
[[Category:Electrolyte disturbances]]


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