When you have chronic illness, it isn’t uncommon to have problems with electrolyte imbalances. Because of that, I’ve decided to do a series that talks about what they are, how the body uses them and things that we can do to manage our electrolytes. For the next seven weeks, I will make a post on Wednesday about one of the electrolytes.
Today we are talking about Chloride. While this is one of the electrolytes generally not discussed, it is highly important in our bodies. Chloride is, after sodium, the most abundant electrolyte in serum, with a key role in the regulation of body fluids, electrolyte balance, the preservation of electrical neutrality, acid-base status and it is an essential component for the assessment of many pathological conditions. The normal adult value for chloride is 97-107 mEq/L.
Hyperchloremia is an electrolyte imbalance and is indicated by a high level of chloride in the blood, above 107. Your kidneys control the levels of chloride in your blood. Therefore, when there is a disturbance in your blood chloride levels, it is often related to your kidneys.
Causes of hyperchloremia may include:
- Loss of body fluids from prolonged vomiting, diarrhea, sweating or high fever (dehydration).
- High levels of blood sodium.
- Kidney failure, or kidney disorders
- Diabetes insipidus or diabetic coma
- Drugs such as: androgens, corticosteroids, estrogens, and certain diuretics.
- intake of too much saline solution while in the hospital, such as during a surgery
- ingestion of salt water
- bromide poisoning
- renal or metabolic acidosis, which happens when the kidneys don’t properly eliminate acid from the body or the body makes an excess of acid
Hyperchloremia doesn’t usually present with symptoms directly. If there are symptoms, it is usually from having a high sodium level, dehydration or an elevated blood sugar rather then the elevated chloride it self. The most common symptoms associated with hyperchloremia are the symptoms of acidosis which include: fatigue, muscle weakness, excessive thirst, dry mucous membranes and high blood pressure.
The treatment of hyperchloremia is focused completely on the cause of the elevation and correcting that matter. There isn’t a way that we can directly lower the chloride levels in the blood without correcting the underlying source.
Hypochloremia is an electrolyte imbalance that occurs when there’s a low amount of chloride in your body, below 97. There often won’t be symptoms of hypochloremia. Instead, there will be symptoms of other electrolyte imbalances or from a condition that’s causing hypochloremia. Usually, the presenting symptoms are that of hyponatremia (low sodium levels).
Hypochloremia is most often caused by a problem with the kidneys since the levels in your blood are regulated by the kidneys. However it can also be caused by:
- congestive heart failure
- prolonged diarrhea or vomiting
- chronic lung disease, such as emphysema
- metabolic alkalosis, when your blood pH is higher than normal
- Certain types of drugs, such as laxatives, diuretics, corticosteroids, and bicarbonates.
- chemotherapy treatment
Hypochloremia is treated by giving normal saline fluids through an IV or by giving sodium chloride tablets orally. It is almost always the case that sodium is low when the chloride is low, thus the replacement of choice is to give them together. It is also essential that the underlying cause of the low level is addressed. If this is a chronic problem, increasing chloride intake in your diet can also help.
Most of the time, sodium chloride is the supplement used to replace chloride because it is almost always the case that the sodium is also low when the chloride level is low. However, it is also possible to take magnesium chloride or potassium chloride. Your doctor will tell you which chloride supplement is the best choice for you based on what your other electrolyte levels are. But the majority of people will be put on sodium chloride. Thus, this supplement discussion will be talking about sodium chloride (that’s salt).
When talking about salt supplementation, it is also important to talk about water consumption. When starting a salt supplement to increase the sodium and/or chloride levels in your body, it is important that you don’t increase your fluid intake when you increase your salt intake. A general guideline is to monitor the color of your urine. Increasing your salt intake will make you feel thirsty even when you don’t need more water. If you think you need more fluids, first check the color of your urine. If your urine is pale yellow then your fluid intake is good and you don’t need to increase your fluid intake. It will be important to have both the sodium and chloride levels in your blood monitored while you are taking the supplement to ensure that you are reaching the desired blood levels without increasing them too much.
There are some things to keep in mind when you are adding a salt supplement to your regime. It is important to start with a small amount and increase the dose over time until you get to the desired amount. This will allow your body to get used to the increased salt in a more gradual way. Sodium Chloride tablets generally come in 1 gram doses. It’s a good idea to start off by taking a quarter tab then increasing by a quarter tab every 2 weeks until you have reached the full 1 gram. Your pharmacist is a great resource for titrating up on your dose when you are first starting out.
If you are having loose stools after starting a salt supplement, it means that your body is not absorbing the salt and it is being flushed out of your gut with water. To improve your body’s ability to absorb the salt, break up the total daily amount into smaller doses spread out over the day. This will also make it less likely that you will increase your thirst drive. Adding in fiber or Imodium may reduce your loose stools, but neither will change the fact that you are not absorbing the salt that you are taking. You may also need to look at the other medications that you are taking as they might effect your body’s ability to absorb the salt. Your pharmacist is a great resource for trouble shooting this problem.
It is not uncommon for salt to cause nausea or vomiting. If you have problems with this, first try taking the salt with food. Again, dividing the total daily amount into smaller doses through out the day can be helpful with this side effect. If you continue to have problems with nausea you can try dissolving the tablet into a small amount of warm water and then mixing the salt solution with a flavored beverage. This will allow you to slowly sip on the drink over several hours , making it less likely to irritate your stomach. If this method works for you, consider Gatorade zero as an alternative to a salt tablet. Each bottle of Gatorade zero has 270mg of sodium along with 270mg of Chloride. While the Chloride isn’t on the label, salt is made from an equal ratio of sodium and chloride. But this method of mixing with water should be used with caution when trying to increase a low sodium and chloride levels. If you use this, you will need to reduce your fluid intake else where to ensure that you are not just flushing out the electrolytes that you are supplementing. For some, taking a nausea medication is required to get past the nausea side effect of salt supplementation. Again, consider consulting your pharmacist if you are having trouble with nausea as it might be an issue of what medications you are taking with the sodium supplement.
Chloride in the Diet
Chloride is naturally found in all unprocessed foods, although in very small amounts. For example, raw and unprocessed fish and meat can contain up to 4 mg of chloride per gram of food, while fruits and vegetables usually stay below 1 mg of chloride per gram of food. It’s the chloride added to foods as table salt or through food additives (during cooking or food processing), that most contribute to our daily intake of this mineral.
Whether you are looking to increase or decrease your chloride levels, you will need to become aware of the salt levels in your diet. Most processed foods are high in salt. When buying food, checking the food labels can help you figure out what foods are good choices for you. A low salt food is one with less than 140mg sodium and chloride per serving. High salt foods are ones with more then 400mg per a serving.
The easiest way to control your salt intake is to do your own cooking. That way you can choose not to add any salt or to add in as much as you need to. Another good way to take control of your salt is with the salt shaker. If you are looking to reduce your salt intake, removing the salt shaker from your table can dramatically reduce the amount of salt you take in. On the other hand, if you are looking to increase your salt, the salt shaker can be a strong ally by adding salt to everything you eat.
Those who are looking to add salt to their diets often struggle to add salt while not eating unhealthy foods. There are salty foods that are also good for you! Consider adding: pickles, olives, nuts, seeds, nut butters, fermented foods, canned sea foods, cottage cheese, and canned beans.
Your Primary Care Provider (PCP) really will be your best ally when managing a supplement. They will be the person that will be ordering your monitoring lab work to make sure that your supplementation is meeting your goals. They will also be the ones that will help you make sure that you are taking the right amount of the supplement. Not to mention it is most likely going to be your PCP who is helping you manage those underlying conditions that is causing you to have to take a supplement in the first place. It is also possible that your supplements could interact with medications that you are taking. Your PCP and your pharmacist are your best allies for monitoring for these possible interactions. So it is super important to keep your doctor in the loop whenever you are adding in supplements.