Synopsis

Source of validity: Scientific
Rating (out of 5): 5

Chloride is scientifically validated as a critical component in the treatment of alkalosis, particularly metabolic alkalosis. Metabolic alkalosis is characterized by an elevated blood pH due to excessive loss of hydrogen ions or a significant gain in bicarbonate. One of the most common causes is the loss of gastric acid (which contains hydrochloric acid) through vomiting or nasogastric suction. This loss leads to both a reduction in hydrogen ions and a concurrent depletion of chloride (hypochloremia).

Chloride plays a central role in renal handling of bicarbonate. The kidneys excrete bicarbonate in exchange for chloride in the renal tubules, a process known as the chloride-bicarbonate exchanger. When chloride is depleted, the kidney’s ability to excrete bicarbonate is impaired, perpetuating the alkalosis. Repletion of chloride—usually with intravenous sodium chloride or potassium chloride—restores the chloride-bicarbonate exchange, allowing for enhanced bicarbonate excretion and correction of the alkalosis.

Numerous clinical guidelines and medical textbooks recommend chloride-containing fluids as first-line therapy for chloride-responsive metabolic alkalosis. This is supported by decades of physiological research and clinical experience. The use of chloride in this context is not simply traditional; it is evidence-based and fundamental to the pathophysiology of the condition.

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