関: hyperchloremic

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/05/09 12:38:07」(JST)

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Hyperchloremia is an electrolyte disturbance in which there is an abnormally elevated level of the chloride ion in the blood. The normal serum range for chloride is 97 to 107 mEq/L. Hyperchloremia is defined as a chloride concentration exceeding this level.Hyperchloremia can affect oxygen transport.^[1]

Symptoms

Often hyperchloremia does not produce any symptoms. In cases where symptoms develop, manifestation resembles hypernatremia. Reduction in blood chloride leads to cerebral dehydration; symptoms are most often caused by rapid rehydration which results in cerebral edema. If the sufferer were to be a diabetic, hyperchloremia could lead to poor control of blood sugar concentration, which could cause it to become elevated. Hyperchloremia can be symptomatic with signs of Kussmaul's breathing, weakness, and intense thirst.

Causes

Elevations in chloride may be associated with administration significant amounts of IV normal saline, diarrhea, certain kidney diseases as type 2 renal tubular acidosis, type 1 renal tubular acidosis, and overactivity of the parathyroid glands. Hyperchloremia is often comorbid with diabetes or hyponatremia. Certain drugs, especially diuretics such as carbonic anhydrase inhibitors, hormonal treatments, and polypharmacy, may contribute to this disorder.

Treatment

As with most types of electrolyte imbalance, the treatment of high blood chloride levels is based on correcting the underlying cause.

If the patient is dehydrated, therapy consists of establishing and maintaining adequate hydration.
If the condition is caused or exacerbated by medications or treatments, these may be altered or discontinued, if deemed prudent.
If there is underlying kidney disease (which is likely if there are other electrolyte disturbances), then the patient will be referred to a nephrologist for further care.
If there is an underlying dysfunction of the endocrine or hormone system, the patient will likely be referred to an endocrinologist for further assessment.

References

^ Cambier C, Detry B, Beerens D, et al. (October 1998). "Effects of hyperchloremia on blood oxygen binding in healthy calves". J. Appl. Physiol. 85 (4): 1267–72. PMID 9760315.

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English Journal

581: CLINICAL IMPACT OF HYPERCHLOREMIA SECONDARY TO HYPERTONIC SODIUM CHLORIDE ADMINISTRATION.

Welch P, Droege C, Winter J, Ernst N, Keegan S, Sangha K, Mueller E.
Critical care medicine.Crit Care Med.2015 Dec;43(12 Suppl 1):147.
PMID 26570242

534: HYPERCHLOREMIA IS CORRELATED TO ACUTE KIDNEY INJURY IN SAH POPULATION TREATED WITH HYPERTONIC SALINE.

Sadan O, Kandiah P, Singbartl K, Martin K, Samuels O.
Critical care medicine.Crit Care Med.2015 Dec;43(12 Suppl 1):135.
PMID 26570195

Acquired Fanconi syndrome in a dog exposed to jerky treats in Japan.

Igase M1, Baba K, Shimokawa Miyama T, Noguchi S, Mizuno T, Okuda M.
The Journal of veterinary medical science / the Japanese Society of Veterinary Science.J Vet Med Sci.2015 Dec 1;77(11):1507-10. doi: 10.1292/jvms.15-0180. Epub 2015 Jun 11.
A 6-year-old spayed female Jack Russell Terrier presented with a 1-month history of lethargy, anorexia, vomiting and weight loss. The dog was fed beef and chicken jerky treats daily in addition to a commercial diet. Laboratory tests revealed azotemia, hypokalemia, hyperchloremia, metabolic acidosis
PMID 26062568