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Micronutrients
Published in Chuong Pham-Huy, Bruno Pham Huy, Food and Lifestyle in Health and Disease, 2022
Chuong Pham-Huy, Bruno Pham Huy
Chloride is an important component of diagnostic tests in different clinical situations. Hypochloremia is usually defined as serum chloride levels below 96–101 mmol/l, while hyperchloremia normally is defined as serum chloride levels higher than 106–111 mmol/l (15). Hypochloremia is often secondary to vomiting, diuretic therapy (furosemide, chlorothiazide), and renal disease. Excessive depletion of chloride ions through losses in the gastric secretions or by deficiencies in the diet may lead to alkalosis due to an excess of bicarbonate, since the inadequate level of chloride is partially compensated for or replaced by bicarbonate (8, 15). Chloride is excreted in the feces, sweat, and urine primarily as sodium or potassium chloride, and secondarily as ammonium chloride when the environment is alkaline (8).
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Published in Samar Razaq, Difficult Cases in Primary Care, 2021
Acute salt loss in CF may lead to the gradual development of abnormally low serum electrolyte levels (hypochloraemia, hypokalaemia and hyponatraemia) and metabolic alkalosis with a failure to thrive. Weight gain resumes with replacement of the lost salts (Kennedy, et al., 1990). Excessive ingestion of milk or calcium carbonate as antacids may lead to hypercalcaemia, alkalosis and renal failure (milk-alkali syndrome). Undiagnosed diabetes, a recognised complication of CF, may result in metabolic acidosis in the form of diabetic ketoacidosis (rather than alkalosis). Pyloric stenosis may cause a similar alkalotic picture and has been discussed elsewhere. It is not a recognised complication of CF. Imerslund–Gräsbeck syndrome is another autosomal recessive disorder, resulting in an inability to absorb vitamin B12.
PerformLyte—A Prodosomed PL425 PEC Phytoceutical-Enriched Electrolyte Supplement—Supports Nutrient Repletion, Healthy Blood pH, Neuromuscular Synergy, Cellular and Metabolic Homeostasis
Published in Abhai Kumar, Debasis Bagchi, Antioxidants and Functional Foods for Neurodegenerative Disorders, 2021
Bernard W. Downs, Manashi Bagchi, Bruce S. Morrison, Jeffrey Galvin, Steve Kushner, Debasis Bagchi
Following is a snapshot of consequences of hyperchloremia128 (a massive increase in chloride level) and hypochloremia (a significant reduction in chloride level): Hyperchloremia causes diarrhea, kidney diseases, and hyperactivity of the parathyroid glands, which ultimately demineralize the skeletal tissues.126,127Hypochloremia is caused by heavy sweating and vomiting in the diseases of adrenal glands and kidneys.127–129
Prevention and treatment of burn wound infections: the role of topical antimicrobials
Published in Expert Review of Anti-infective Therapy, 2022
Deepak K. Ozhathil, Steven E. Wolf
The most common adverse effect is disturbance electrolytes (hyponatremia and hypochloremia). This is due to silver ions binding to chlorine ions, causing silver salts to precipitate as brownish stain on the patient. As a result, patients treated with silver nitrate are always identifiable by this discoloration. Silver nitrate also has poor eschar penetration and requires repeat administration to maintain antimicrobial inhibition. Lastly, methemoglobinemia, due to the chemical reduction of nitrate compounds, is an infrequent complication [42]. Summary: Silver nitrate combined with nystatin is an excellent first line agent for post-operative topical antimicrobial therapy. It is effective against many common pathogens and has a negligible cytotoxic profile, even on split thickness skin grafts. However, it is ineffective against a number of microbial genera, so its use should be coupled with awareness of the wound microbiome. In addition, because it can precipitate electrolyte disturbances, caution should be used when used on patients with large TBSA burns and pre-existing conditions.
Asymptomatic hyponatremia precipitated by COVID-19 pneumonia
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Abhinandan R. Chittal, Shiavax J. Rao, Pallavi Lakra, Mary E. Zulty
Laboratory diagnostics revealed hyponatremia (111 mEq/dL; reference range: 137–145mEq/dL), potassium of (4.1 mEq/dL; reference range: 3.5–5.1 mEq/dL), hypochloremia (76 mEq/dL; reference range: 98–107 mEq/dL), BUN of (14 mg/dL; reference range: 7–17 mg/dL) and creatinine of (0.91 mg/dL; reference range: 0.52–1.04 mg/dL). Serum osmolality was 231 mOsm/kg (reference range: 275–300 mOsm/kg). Complete blood count revealed anemia (11.6 g/dL; reference range: 11–14.5 g/dL), leukocyte count 4.6 K/uL (4.0–10.8 K/uL), platelet count 284 K/uL (reference range: 145–400 k/uL). COVID-19 RNA PCR was positive. Urinalysis was unremarkable. Urine chemistry showed urine chloride 98 mmol/L (27–283 mmol/L), urine osmolality 454 mOsm/kg (reference range 300–900 mOsm/kg), urine potassium 56.8 mmol/L (reference range 35–336 mmol/L), urine sodium 72 mmol/L (reference range 32–112 mmol/L), urine protein 16 mg/dL (0–16 mg/dL). Further diagnostics revealed morning cortisol level of 14.2 mcg/dL (5.0–23 mcg/dL), TSH 0.12 uIU/ml (0.4–4.0 uIU/ml), T4 1.03 ng/dL (reference range 0.9–2.3 ng/dL). EKG revealed: Normal sinus rhythm and possible left atrial enlargement. Plain-film chest radiograph revealed an enlarged cardiac silhouette and diffuse interstitial prominence.
Treating potassium disturbances: kill the killers but avoid overkill
Published in Acta Clinica Belgica, 2019
R. Vanholder, W. Van Biesen, E. V. Nagler
The list of potential renal causes of hypokalemia is more extended than that of non-renal causes. Some of the major causes of renal hypokalemia are attributable to hypochloremia. Hypokalemia due to vomiting or gastric aspiration is mainly due to urinary excretion of potassium, which acts as a counter-ion for bicarbonate. The latter is excreted via the urine to correct the excess bicarbonate that is present in the serum as compensation for the chloride deficit. Renin angiotensin aldosterone system activation induced by dehydration further increases urinary potassium loss. Similar mechanisms are seen with diuretic-induced hypokalemia, and a few congenital disorders imposing renal Cl− losses (Gitelman and Bartter syndromes).