Fluid & Electrolyte Q 2

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Lee Angela’s lab test just revealed that her chloride level is 96 mEq/L. As a nurse, you would interpret this serum chloride level as:

  

    A. High

    B. Low

    C. Within normal range

    D. High normal

    

    

Correct Answer: C. Within normal range

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Normal serum concentrations of chloride range from 95 to 108 mEq/L. Chloride is an anion found predominantly in the extracellular fluid. The kidneys predominantly regulate serum chloride levels. Most of the chloride, which is filtered by the glomerulus, is reabsorbed by both proximal and distal tubules (majorly by proximal tubule) by both active and passive transport.

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Option A: Hyperchloremia is an electrolyte disturbance in which there is an elevated level of the chloride ions in the blood. The normal serum range for chloride is 95 to 108 mEq/L, therefore chloride levels at or above 110 mEq/L usually indicate kidney dysfunction as it is a regulator of chloride concentration.

Option B: The most reduced levels of serum chloride (range 45 to 70 mEq/L) are associated with pernicious forms of vomiting due to gastric outlet obstruction, protracted vomiting in alcoholics, or self-induced vomiting. Individuals with hypochloremia secondary to total body chloride depletion will have physical findings that indicate ECF volume contraction (e.g., hypotension, tachycardia, and orthostatic changes in blood pressure).

Option D: Conditions causing an elevation of the serum chloride concentration and a concomitant elevation of the serum sodium concentration result primarily from disorders associated with loss of electrolyte-free fluids (pure water loss); hypotonic fluids (water deficit in excess of sodium and chloride deficits); or administration of NaCl-containing fluids.

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