Chloride, Serum
What is a chloride blood test?
A chloride blood test (serum chloride) measures the level of chloride in your blood. Chloride is one of the electrolytes in your blood. Electrolytes are minerals that carry an electric charge when they are dissolved in a liquid. The electrolytes in your blood — chloride, sodium, potassium and bicarbonate — help control nerve and muscle function and maintain the acid-base balance (pH balance) of your blood and your water balance. The amount of chloride in your blood is often measured along with other electrolytes to diagnose or monitor certain medical conditions, including:
- Kidney disease.
- Heart failure.
- Liver disease.
- High blood pressure.
- What is a chloride blood test used for?
Healthcare providers usually don’t order individual chloride blood tests. Chloride blood tests are usually included in the following routine blood tests and screenings that measure multiple things in your blood:
- Comprehensive metabolic panel (CMP).
- Basic metabolic panel (BMP).
- Electrolyte panel.
The results of a chloride blood test, alongside the results of other electrolyte tests, can help diagnose a condition related to an imbalance of acids or fluids in your body.
Why do I need a chloride blood test?
Your healthcare provider may have ordered a chloride blood test as part of a routine blood panel. Your healthcare provider may also order a chloride blood test if you have symptoms of an acid or fluid imbalance, including:
- Experiencing multiple instances of vomiting.
- Having diarrhea.
- Feeling very tired (fatigue).
- Feeling weak.
- Experiencing dehydration.
- Having difficulty breathing (respiratory distress).
What is a normal chloride blood test result?
A typical normal range for a chloride blood test for an adult is 96 to 106 milliequivalents per liter (mEq/L) or 96 to 106 millimoles per liter. However, laboratories may have different reference ranges for normal chloride levels. When you get your blood test results back, there will be information that indicates what that lab’s normal blood chloride range is. If you have any questions about your results, be sure to ask your healthcare provider.
Sources:
- Chloride Test -- https://www.testing.com/tests/chloride/
- Health Encyclopedia, Chloride -- https://www.urmc.rochester.edu/encyclopedia/content.aspx?ContentTypeID=167&ContentID=chloride
- Blood Tests -- https://www.nhlbi.nih.gov/health/blood-tests
- MedlinePlus. Chloride Blood Test -- https://medlineplus.gov/lab-tests/chloride-blood-test
- Merck Manual Consumer Version. Overview of Electrolytes -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/overview-of-electrolytes
References:
American Board of Internal Medicine. ABIM Laboratory Test Reference Ranges -- https://www.abim.org/Media/bfijryql/laboratory-reference-ranges.pdf
Lewis JL III. Overview of Electrolytes. Merck Manual Consumer Edition -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/electrolyte-balance/overview-of-electrolytes
A.D.A.M. Medical Encyclopedia. Chloride Test – Blood -- https://medlineplus.gov/ency/article/003485.htm
Hinkle J, Cheever K. Brunner & Suddarth's Handbook of Laboratory and Diagnostic Tests. 2nd Ed, Kindle. Philadelphia: Wolters Kluwer Health, Lippincott Williams & Wilkins; c2014. Chloride, Serum; p. 153–4.
Merck Manual Consumer Version: Merck & Co. Inc.; c2022. Acidosis -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/acidosis
Merck Manual Consumer Version: Merck & Co. Inc.; c2022. Addison Disease (Addison's Disease; Primary or Chronic Adrenocortical Insufficiency) -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/adrenal-gland-disorders/addison-disease
Merck Manual Consumer Version: Merck & Co Inc.; c2022. Acidosis -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/acidosis
Merck Manual Consumer Version: Merck & Co. Inc.; c2022. Overview of Acid-Base Balance -- https://www.merckmanuals.com/home/hormonal-and-metabolic-disorders/acid-base-balance/overview-of-acid-base-balance
Merck Manual Professional Version: Merck & Co. Inc.; c2022. Acid-Base Disorders -- http://www.merckmanuals.com/professional/endocrine-and-metabolic-disorders/acid-base-regulation-and-disorders/acid-base-disorders
National Heart, Lung, and Blood Institute: U.S. Department of Health and Human Services; Blood Tests -- http://www.nhlbi.nih.gov/health-topics/blood-tests
Adrogué HJ, Madias NE. Respiratory acidosis, respiratory alkalosis, and mixed disorders. In: Feehally J, Floege J, Tonelli M, Johnson RJ, eds. Comprehensive Clinical Nephrology. 6th ed. Philadelphia, PA: Elsevier; 2019:chap 14.
Giavarina D. Blood biochemistry: measuring major plasma electrolytes. In: Ronco C, Bellomo R, Kellum JA, Ricci Z, eds. Critical Care Nephrology. 3rd ed. Philadelphia, PA: Elsevier; 2019:chap 54.
Seifter JR. Acid-base disorders. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 110.
What does it mean if your Chloride, Serum result is too high?
What does a high chloride level mean?
If your results reveal that you have higher-than-normal levels of chloride in your blood, it may indicate that you have:
- Dehydration.
- Kidney disease.
- Cushing’s syndrome.
- Metabolic acidosis (having too much acid in your blood, or a lower-than-normal blood pH).
- Respiratory alkalosis (having a low level of carbon dioxide in your blood due to breathing excessively, or hyperventilating).
An increased level of blood chloride is typically caused by dehydration but may also occur with problems that cause high blood sodium (such as Cushing syndrome or kidney disease). A high amount of chloride also occurs when too much base is lost from the body (causing metabolic acidosis) or when a person hyperventilates (causing respiratory alkalosis).
It’s important to remember that a high chloride result doesn’t necessarily mean that you have a medical condition. Certain situations and medications can also increase your chloride levels.
To lower chloride levels in the blood, it is crucial to address the underlying cause. Here are some general strategies that might help:
→ Dietary modifications: Avoiding high-chloride foods like table salt and processed foods can be beneficial.
→ Hydration: Increasing water intake can dilute chloride levels in the blood.
→ Medication adjustment: Consult a healthcare professional to assess any medications that might be contributing to high chloride levels.
The most effective approach would depend on the specific cause of elevated chloride levels. Consulting a healthcare provider for personalized guidance and treatment is crucial.
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What does it mean if your Chloride, Serum result is too low?
What Does a Decreased Chloride (Serum) Level Mean?
Chloride is an essential electrolyte that helps maintain your body’s acid-base balance, fluid levels, and electrical neutrality in cells. It works closely with sodium, potassium, and bicarbonate to regulate hydration and pH. Serum chloride levels are routinely measured as part of a Comprehensive Metabolic Panel (CMP)—even when the test is done without fasting.
A low chloride level in the blood is called hypochloremia. It can reflect fluid imbalances, acid-base disturbances, or be a secondary effect of various underlying medical conditions or medications.
Common Causes of Low Chloride Levels
1. Prolonged Vomiting or Nasogastric Suction
Loss of stomach contents (which are rich in hydrochloric acid) leads to a loss of chloride and hydrogen ions, resulting in metabolic alkalosis.
2. Chronic Respiratory Conditions
Conditions such as chronic obstructive pulmonary disease (COPD) can cause chronic CO2 retention, leading to compensatory metabolic alkalosis with low chloride.
3. Diuretic Use
Loop diuretics and thiazide diuretics (commonly prescribed for high blood pressure or heart failure) increase urinary loss of chloride, sodium, and potassium.
4. Excessive Water Intake or Dilutional States
Excessive intake of free water (or conditions like SIADH, Syndrome of Inappropriate Antidiuretic Hormone Secretion) can dilute blood chloride levels.
5. Congestive Heart Failure or Liver Cirrhosis
Both conditions may cause fluid retention and dilutional hyponatremia, often accompanied by low chloride.
6. Metabolic Alkalosis
Low chloride levels often appear alongside high bicarbonate levels, reflecting a shift in acid-base balance.
Associated Symptoms of Hypochloremia
While mild cases may have no symptoms, moderate to severe hypochloremia can cause:
-
Muscle twitching or weakness
-
Dehydration
-
Fatigue
-
Difficulty breathing (if associated with acid-base disturbances)
-
Confusion or irritability (in severe cases)
How Is It Diagnosed?
A Comprehensive Metabolic Panel (CMP) includes chloride along with sodium, potassium, CO2 (bicarbonate), and other metabolic markers. Low chloride is often evaluated alongside:
-
Sodium and bicarbonate levels
-
Kidney function markers (creatinine, BUN)
-
Arterial blood gases (ABG) in complex cases
What Should You Do if Your Chloride is Low?
A single low chloride result—especially from a non-fasting test—should be interpreted in the context of:
-
Hydration status
-
Medications (especially diuretics)
-
Recent illness (vomiting, diarrhea, infections)
-
Other lab values on the CMP
Your healthcare provider may:
-
Review your medications
-
Order follow-up electrolyte tests or blood gas analysis
-
Recommend adjustments to your diet or fluid intake
-
Address any underlying conditions such as kidney disease, heart failure, or acid-base imbalance
Summary
A decreased serum chloride level on a non-fasting Comprehensive Metabolic Panel may suggest an electrolyte imbalance, often due to vomiting, diuretic use, chronic respiratory illness, or metabolic alkalosis. While not always a cause for concern, persistently low levels may require further evaluation and treatment depending on the underlying cause.
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