Chloride is the most abundant extracellular anion. Measurements of serum chloride are not useful for routine screening but may help in the evaluation of acid-base disturbances.

The reference range of chloride is 98 to 109 mmol/L. In volume expansion, serum chloride generally increases, and in volume depletion, serum chloride is reduced. Hypochloremia occurs with loss of chloride-containing body fluids, such as with prolonged vomiting, burns, diuretic use, and salt-wasting nephropathy. Hypochloremia is commonly seen with metabolic alkalosis. Hyperchloremia occurs with non-anion gap metabolic acidosis, usually related to diarrhea or renal tubular acidosis, and with administration of large amounts of sodium chloride.

Urine chloride levels are useful in the evaluation of metabolic alkalosis. Low urine chloride (<10 mmol/L) is present with chloride-responsive causes of alkalosis, such as vomiting with volume depletion. Elevated levels of urine chloride (>20 mmol/L) are present in conditions associated with mineralocorticoid excess, such as hyperaldosteronism and hypercortisolism.

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