CC2/LAO/2013-2014 ELECTROLYTES 1

CHLORIDE
- Major extracellular anion
- Involved in the maintaining osmolality, blood volume, and electric neutrality
- Cl- shifts secondarily to a movement of Na+ or HCO3-
- Ingested in the diet is completely completely absorbed by the intestinal tract 
filtered out by the glomerulus  passively reabsorbed by in conjuction with
sodium by the proximal tubules
- Excess Cl- is secreted in the urine and sweat
- Excessive sweating stimulates aldosterine secretion  acts on sweat gland to
conserve Na+ and Cl-

Maintains neutrality in 2 ways:

- Sodium is reabsorbed along with Cl- in the proximal tubules  Cl- acts as the
rate-limiting component  Na+ reabsorption is limited by amount available
- Chloride shift
o Carbon dioxide generated by the cellular metabolism within the tissue
o Diffuses into both the plasma and the red cells
o Carbon dioxide forms carbonic acid (H2CO3)
o Splits into H+ and bicarbonate
o Deoxyhemoglobin buffers H+ whereas HCO3 diffuses out into the plasma
o Cl- diffuses into the red cell to maintain the electric balance of the cell

MBCL/2014
CC2/LAO/2013-2014 ELECTROLYTES 2

HYPOCHLOREMIA
- Chloride passively follows sodium
- May also occur with excessive loss of Cl-
- Prolonged vomiting
- Diabetic ketoacidosis
- Aldosterone deficiency
- Salt-losing renal diseases
o Associated with high serum bicarbonate such as compensated respiratory
acidosis
- Metabolic alkalosis

HYPERCHLOREMIA
- Excess loss of HCO3- as a result of GI losses
- RTA
- Metabolic acidosis

DETERMINATION
Specimen:
a. Serum or plasma (with lithium heparin)
b. HEMOLYSIS must be avoided
c. WHOLE BLOOD may be used depending on the machine
Methods
a. ISEs
a. Most commonly used method
b. Uses an ion-exchange membrane to selectively bind Cl-
b. Amperometric-Coulometric titration
a. Using coulometric generation of silver ions which combines with Cl- to
quantitate the Cl- concentration
c. Mercuric Titration
d. Colorimetry

REFERENCE VALUE
- Plasma/Serum 98-107 mmol/L
- Urine (24 h) 110-250 mmol/day

MBCL/2014