Chlorides in urine

The amount of chlorine in the urine depends on its content in the food. In infants with urine, very little chlorine is excreted, since its content in breast milk is low. The transition to mixed nutrition leads to a significant increase in the content of chlorine in the urine. Its amount in the urine increases in accordance with the ever increasing use of table salt. Approximately 90% of food chlorides are excreted in urine and only 6% - with sweat. The reference values ​​of urinary chlorine are given in the table.

Table Reference values ​​of urinary chloride chlorine

Table Reference values ​​of urinary chloride chlorine

Hypochloruria develops due to the release of an increased amount of chlorine with sweat, vomit and through the intestine. Hypochloruria, as a rule, accompanies hypochloremia in diarrhea and vomiting of various etiologies, with feverish diseases. With pneumonia as a result of the so-called "dry" chlorine retention( due to the release of chlorine to the tissues), its content in the urine decreases. Cardiovascular decompensation with

development of edema, inflammatory effusions, edema formation in kidney diseases are accompanied by a "wet" retention of chlorine in the body( due to the transition of chlorine to the extracellular fluid), and hypochloruria also occurs.

Violation of the processes of endocrine regulation of water-electrolyte metabolism with increasing function of the adrenal cortex and pituitary gland can be accompanied by hypochloruria with hyperchloremia as a result of reverse absorption of chlorine in the renal tubules.

Hyperchloruria as a physiological phenomenon is possible with significant introduction of sodium chloride into the body. As a pathological phenomenon, hyperchlororia occurs less frequently and accompanies the processes of resorption of edema, exudates and transudates, and it occurs simultaneously with hyperchloremia. The recovery period for infectious diseases, pneumonia is accompanied by the return of chlorides and hyperchloria.

There is no direct correlation between the chlorine content in the blood and its excretion in the urine.

Determination of the content of chlorine in urine is of great diagnostic value in intensive care patients in severe condition. This study has particular importance for establishing the causes of metabolic alkalosis and the possibility of its correction by the introduction of chlorine. There are the following types of metabolic alkalosis.

■ Chloride-sensitive alkalosis with a chloride concentration in the urine below 10 mmol / l is the most common form of metabolic alkalosis, usually it is accompanied by a decrease in the volume of extracellular fluid. It can occur with the loss of chlorine through the digestive tract( vomiting, aspiration of the stomach contents, villous adenoma and congenital chloridorrhea) or with the use of diuretics( due to the concomitant decrease in the volume of extracellular fluid and hypokalemia).It should always be considered that the introduction of a large dose of diuretics can even increase the level of chlorine in the urine;This should be borne in mind when assessing metabolic alkalosis and the results of the determination of chlorine in the urine. Post-hypercapnia states due to stable renal bicarbonate retardation, excessive bicarbonate administration or repeated blood transfusions( overload with citrate) may also cause a chlorine-sensitive metabolic alkalosis.

■ Chloride-resistant alkalosis with a chlorine content in urine above 20 mmol / l is observed much less often. Except for cases of Bartter's syndrome and magnesium deficiency in the body, with arthritic hypertension, alkalosis of this type is usually observed, and the volume of extracellular fluid is not reduced. Other causes of alkalosis of this type are primary aldosteronism, Cushing's syndrome, renal artery stenosis, Liddl's syndrome, hypercalcemia and severe hypo-potassium.