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Chloride F&E - Self Study

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What does Chloride do?
- Contained in gastric juices, pancreatic juices, sweat
- Combined w/Na assists in regulating osmotic pressure in the body;
- Changes concentration in ECF in direct proportion to Na concentrate
- helps maintain acid-balance & CO2 transport in RBCs
- Chloride & Na move together thru the body; so an
imbalance in one causes an imbalance in the other
**Chloride & Bicarbonate have inverse relationship: if one
level rises the other drops
Chlorine
Normal Serum levels: 96 - 106
Hypochloremia Causes
- GI tube drainage
- Severe vomiting & diarrhea
- Chloride-deficit formulas
- Low sodium intake; salt restricted diet
- Decreased sodium or potassium levels
- Metabolic alkalosis
- Prolonged therapy w/IV dextrose (w/o electrolyte supple)
- Diuretic therapy
- Burns
- Excessive losses from GI tract, skin & kidneys
- Heart failiure
Hypochloremia NOTES
- Dependant upon intake of chlorine & excretion & reabsorption of its ions in the kidneys
- Chloride is produced in the stomach (severe N/V affects)
- Small amounts are lost in feces
- Because of volume depletion chloride decreases & Na & bicarbonate are retained by the kidney
Hypochloremia Manifestations
Serum Chloride: <96 mEq/L:
- Agitation
- Irritability
- Tremors
- Muscle cramps & hypertonicity
- Hyperactive deep tendon reflexes
- Tetany
- Slow, shallow respirations
- Seizures
- Dysrhythmias
- Coma
- S/s of acid-base imbalances: hyponatremia, hypokalemia & metabolic alkalosis
*METABOLIC ALAKOSIS: high pH, high bicarbonate level=loss of H ion
Medical Mgmt Hypochloremia
- Correcting the cause & contributing electrolyte & acid base balances
- NS or 0.45NS
- Monitor Diuretics
- Increase chloride intake orally+
- Discourage bottled or filtered water*
- Ammonium chloride may be prescribed
+INTAKE: tomato juice, canned veggies, broth, processed meats & fruits
*BOTTLED WATER: depletes chloride since large amts will be excreted and not replaced
Nursing Diagnosis hypochloremia
- Risk for injury
- Potential Complications: tetany, dysrhythmias, coma
Nursing Interventions hypochloremia
- Monitor I&O
- Monitor ABGs
- Monitor serum electrolyte values
- Monitor LOC
- Monitor muscle strength & movements
- Monitor VS & respiratory status
- Educate about foods high in chloride
Hyperchloremia
Serum chloride >106 mEq/L
Hyperchloremia Causes
- Hypernatremia
- Bicarbonate loss
- Metabolic acidosis can occur with high chloride levels
RARELY OCCURS ON ITS OWN!!!
Hyperchloremia Manifestations
- Tachypnea
- Lethargy
- Weakness
- Deep rapid respirations
- Decline in cognitive status
- Decreased cardiac output
- Dyspnea: Kussmaul's respirations
- Tachycardia
- Pitting edema
- Dysthythmias
- Coma
Hyperchloremia Lab Results:
- Increased Na chloride
- Increased serum Na
- Decreased serum pH
- Decreased Na bicarbonate
- Normal anion gap
- Increased urinary chloride level
Medical Mgmt: Hyperchloremia
- Correcting the underlying cause
- Restoring electrolyte, fluid & acid-base balance
- LR
- Sodium Bicarbonate IV to increase basic bicarbonate level in liver
- Diuretics
- Restrict Na, fluids & chloride
Hyperchloremia Nursing Diagnosis
- Injury
- Potential Complications: dysthrythmias, coma
Hyperchloremia Nursing Interventions
- Assess respiratory, neurologic & cardiac systems
- Monitor VS
- ABGs
- Monitor I&O
- Encourage low chloride diet
Food sources of Chloride
canned vegetables
eggs
fresh fruits & vegetables
milk
processed meats
salty foods
table salt
seawead
rye
olives
tomatoes
lettuce
celery
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