Hyperchloremic acidosis

Updated on Dec 09, 2023

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Specialty endocrinology ICD-9-CM 276.2		ICD-10 E87.2 eMedicine med/1071

Hyperchloremic acidosis is a form of metabolic acidosis associated with a normal anion gap, a decrease in plasma bicarbonate concentration, and an increase in plasma chloride concentration (see anion gap for a fuller explanation). Although plasma anion gap is normal, this condition is often associated with an increased urine anion gap, due to the kidney's inability to secrete ammonia.

Causes

In general, the cause of a hyperchloremic metabolic acidosis is a loss of base, either a gastrointestinal loss or a renal loss.

Gastrointestinal loss of bicarbonate (HCO−
3)

Severe diarrhea (vomiting will tend to cause hypochloraemic alkalosis)

Pancreatic fistula with loss of bicarbonate rich pancreatic fluid

Nasogastric tube losses in the context of small bowel obstruction and loss of alkaline proximal small bowel secretions

Chronic laxative abuse

Renal causes

Proximal renal tubular acidosis with failure of HCO−
3 resorption

Distal renal tubular acidosis with failure of H+
secretion

Long-term use of a carbonic anhydrase inhibitor such as acetazolamide

Other causes

Ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts

The treatment and recovery phases of diabetic ketoacidosis

Volume resuscitation with 0.9% normal saline provides a chloride load, so that infusing more than 3-4L can cause acidosis

Hyperalimentation (i.e., total parenteral nutrition)

References

Hyperchloremic acidosis Wikipedia

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