What Is Hyperchloremic Metabolic Acidosis?

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  • Written By: Mary McMahon
  • Edited By: Shereen Skola
  • Last Modified Date: 17 September 2019
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Hyperchloremic metabolic acidosis is a drop in the level of acidity within the body, or pH level, that can lead to serious complications if it is not corrected. Samples of fluids from the patient will reveal a higher concentration of sodium in the plasma, along with a drop in the bicarbonate buffer that normally keeps the pH in a safe range. The difference between negatively charged anions and positively charged cations, known as the anion gap, is normal in patients with hyperchloremic metabolic acidosis. All of these diagnostic signs can help a medical provider identify the condition and start exploring possible causes.

This situation can arise in a patient for a number of reasons. One can be loss of bicarbonate through the digestive tract. A fluid imbalance, where the patient rapidly loses fluids or receives an infusion of fluids that isn’t balanced appropriately, can also cause hyperchloremic metabolic acidosis. Patients with kidney failure and severe diabetes can also develop acidosis as a potential complication.


In hospital settings, pH imbalances can be an ongoing concern. Patients who are hospitalized for extended periods of time, especially in intensive care, can be more prone to developing complications like this. Nurses may monitor them closely to make sure they receive appropriate fluids, and check their blood serum for signs that acidosis or the opposite condition, alkalosis, is developing. It can be difficult to keep a severely ill patient stable because systems in the body may be starting to shut down.

Patients with a low pH in the serum and tissues of the body can experience symptoms like headache, chest pains, and nausea. It can be hard to identify acidosis from symptoms alone because they can be associated with so many other medical conditions. Blood testing can reveal abnormal pH in the patient’s plasma, and will also provide information about the specifics of the acidosis. If the anion gap is normal, for example, the patient has hyperchloremic metabolic acidosis, in contrast with other forms of acidosis where it may be elevated.

Treatment may start as soon as possible to decrease the acidity and prevent serious complications like coma and damage to the heart. As the patient is stabilized, tests can continue to find out why the patient developed hyperchloremic metabolic acidosis. This testing is important, as it allows medical providers to take steps to prevent a recurrence of the episode. A case of hyperchloremic metabolic acidosis may reveal an underlying medical problem or could illustrate that a chronic health condition is poorly controlled.


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