Consider the below conditions with hypochloremia, specifically in the setting of metabolic alkalosis. A urinary chloride level will help differentiate these conditions .
- Nasogastric tube suction, such as in NICU and PICU settings
- Severe gastroesophageal reflux
- Pyloric stenosis
- Laxative abuse
- Congenital chloride diarrhea
- Diuretic use
- Chloride-losing nephropathy
- Bartter Syndrome: Genetic defect in chloride transport in kidney
- Gitelman Syndrome: Familial hypokalemia-hypomagnesemia from renal inability to resorb salts
- Cystic fibrosis
The lower end of the normal reference range for chloride levels are slightly different than for adults, especially for those older than 2-3 months old .
|Pediatric Age||Hypochloremia definition|
|Premature infant||Cl <95 mEq/L|
|Newborn||Cl <96 mEq/L|
|Child||Cl <90 mEq/L|
There are no pregnancy-specific causes for hyperchloremia, although the lower end of the normal reference range may be slightly higher in the first trimester .
|Trimester Stage||Hypochloremia definition|
|First||Cl <101 mEq/L|
|Second||Cl <97 mEq/L|
|Third||Cl <97 mEq/L|
Originally published Feb 12, 2023 (updated February 13, 2023)
- Morrison G. Serum Chloride. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 197.
- Desai J. Hypochloremic Metabolic Acidosis. Medscape Section on Pediatrics: Genetics and Metabolic Disease. Published Aug 30, 2018.
- Pagana KD, Pagana TJ, Pagana TN. Mosby’s Diagnostic and Laboratory Test Reference. 14th ed. St. Louis, MO: Elsevier; 2019.
- Abbassi-Ghanavati M, Greer LG, Cunningham FG. Pregnancy and laboratory studies: a reference table for clinicians. Obstet Gynecol. 2009 Dec;114(6):1326-1331. doi: 10.1097/AOG.0b013e3181c2bde8. Erratum in: Obstet Gynecol. 2010 Feb;115(2 Pt 1):387. PMID: 19935037.