When discussing hyperchloremia, a correct statement is that it:
A) has specific symptoms such as thirst.
B) is a result of an underlying disorder.
C) is a primary electrolyte disorder.
D) arises with an excess of bicarbonate.
The correct answer and explanation is:
The correct answer is:
B) is a result of an underlying disorder.
Explanation:
Hyperchloremia refers to an elevated level of chloride ions (Cl⁻) in the blood, typically above the normal range of 96 to 106 mEq/L. Chloride is the major extracellular anion and plays a critical role in maintaining acid-base balance, osmotic pressure, and electrical neutrality.
Why B) is correct:
Hyperchloremia usually does not occur as an isolated or primary disorder; rather, it is almost always secondary to an underlying condition. It often reflects an imbalance caused by other physiological or pathological processes. These may include:
- Dehydration: Loss of water concentrates chloride.
- Metabolic acidosis: Particularly hyperchloremic metabolic acidosis, where bicarbonate levels fall and chloride rises to maintain electrical neutrality.
- Excessive saline administration: Infusion of large amounts of normal saline (0.9% NaCl) can cause hyperchloremia.
- Kidney dysfunction: Impaired renal chloride handling can cause retention.
- Certain medications or conditions causing bicarbonate loss (e.g., diarrhea).
Thus, hyperchloremia is best understood as a marker or consequence of other disturbances rather than a primary disorder.
Why the other options are incorrect:
- A) has specific symptoms such as thirst:
Hyperchloremia itself generally does not produce specific symptoms. Symptoms like thirst are usually related to underlying causes such as dehydration or hypernatremia. The electrolyte imbalance is typically detected via blood tests rather than clinical symptoms alone. - C) is a primary electrolyte disorder:
Hyperchloremia is rarely primary. It usually develops secondary to other electrolyte or acid-base disorders or volume changes. For example, it often accompanies metabolic acidosis due to bicarbonate loss. - D) arises with an excess of bicarbonate:
This is false. Hyperchloremia typically occurs with a loss of bicarbonate, not an excess. When bicarbonate decreases (as in metabolic acidosis), chloride often increases to maintain electrical neutrality, causing hyperchloremia.
Summary:
Hyperchloremia is a secondary condition that signals an underlying problem, most commonly related to acid-base imbalances, fluid volume status, or kidney function. It rarely causes symptoms on its own and almost never occurs as a primary disorder. Treatment focuses on identifying and addressing the root cause rather than the chloride level itself.