Hyperchloremia is an electrolyte imbalance that occurs when there’s too much chloride in the blood. It can develop from excessive diarrhea, kidney disease, certain medications, or other causes.

Chloride is an important electrolyte that maintains the body’s acid-base (pH) balance, regulates fluids, and transmits nerve impulses. The normal range for chloride in adults is roughly between 96 and 106 milliequivalents of chloride per liter of blood (mEq/L).

The kidneys play an important role in regulating chloride in the body, so an imbalance in this electrolyte may be related to a problem with these organs. It can also develop due to other health conditions, including diabetes or severe dehydration, that can affect the kidneys’ ability to maintain chloride balance.

Keep reading to learn more about the symptoms, causes, and treatment of hypercloremia.

Some people may not experience any noticeable symptoms of hyperchloremia, and the condition is sometimes not even noticed until a routine blood test. Symptoms of hyperchloremia are usually linked to the underlying cause of the high chloride level.

Metabolic acidosis often causes high chloride levels. Acidosis happens when the blood is overly acidic. These symptoms may include:

The kidneys regulate your electrolyte levels by filtering the blood and keeping its composition stable, allowing the body to function properly.

Hyperchloremia occurs when the levels of chloride in the blood become too high. This may happen due to:

  • intake of too much saline solution while in the hospital, such as during surgery
  • severe diarrhea
  • chronic or acute kidney disease
  • ingestion of salt water
  • extremely high intake of dietary salt
  • bromide poisoning
  • metabolic acidosis, which happens when the kidneys don’t properly eliminate acid from the body and it builds up in the body
  • respiratory alkalosis, a condition that occurs when the amount of carbon dioxide in your blood is too low (such as when a person hyperventilates)
  • long-term use of drugs called carbonic anhydrase inhibitors, which treat glaucoma and other disorders

Hyperchloremic acidosis, or hyperchloremic metabolic acidosis, occurs when a loss of bicarbonate (alkali) tips the pH balance in your blood toward becoming too acidic (metabolic acidosis). In response, your body holds onto chloride, causing hyperchloremia. In hyperchloremic acidosis, either your body is losing too much base or retaining too much acid.

A base called sodium bicarbonate helps to keep your blood at a neutral pH. A loss of sodium bicarbonate may be caused by:

  • severe diarrhea
  • chronic laxative use
  • proximal renal tubular acidosis, which is the failure of the kidneys to reabsorb bicarbonate from urine
  • long-term use of carbonic anhydrase inhibitors to treat glaucoma, such as acetazolamide (Diamox Sequels)
  • kidney damage

The potential causes of too much acid being introduced to your blood include:

  • accidental ingestion of ammonium chloride, hydrochloric acid, or other acidifying salts (sometimes found in solutions used for intravenous feeding)
  • certain types of renal tubular acidoses
  • intake of too much saline solution in the hospital

Hyperchloremia is typically diagnosed by a chloride blood test. This test is usually part of a larger metabolic panel a doctor may order.

A metabolic panel measures the levels of several electrolytes in your blood, including:

  • carbon dioxide or bicarbonate
  • chloride
  • potassium
  • sodium

Normal chloride levels for adults are in the 96–106 mEq/L range. If your test shows a chloride level higher than 106 mEq/L, you have hyperchloremia. Normal ranges may sometimes differ by lab.

If you have high levels, a doctor may also test your urine for chloride and your blood sugar levels to see if you have diabetes. A basic urinalysis can help detect problems with your kidneys. The pH can indicate if you’re properly eliminating acids and bases.

The exact treatment for hyperchloremia will depend on its cause:

  • For dehydration, treatment usually includes hydration.
  • If you receive too much saline through an IV, the supply of saline will be stopped until you recover. You may have an IV with another solution to help balance your levels.
  • For hyperchloremia due to medication, a doctor might modify your dose or stop the medication.
  • If you have kidney damage or another health condition affecting the kidneys, a doctor will likely refer you to a nephrologist, a doctor specializing in kidney health. If your condition is severe, you may need dialysis to filter your blood instead of your kidneys.
  • Hyperchloremic metabolic acidosis may be treated with a base called sodium bicarbonate.

If you have hyperchloremia, try to stay hydrated. It’s also best to avoid caffeine and alcohol, as these can make dehydration worse.

An excess of chloride in your body can be very dangerous because of the link to higher-than-normal acid in the blood. If it isn’t treated promptly, it can lead to:

The outlook depends on what caused the hyperchloremia and how quickly it’s treated.

People who don’t have kidney problems should be able to recover easily from hyperchloremia caused by receiving too much saline.

Hyperchloremia is an electrolyte imbalance caused by too much chloride in the blood. It usually results from another health condition, such as dehydration or acidosis, which occurs when the blood becomes too acidic.

The treatment of hyperchloremia depends on the underlying cause. It may include hydration or changing medications. Severe hyperchloremia may require dialysis.