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Chloride is the major extracellular anion. Its precise function in the body is not well understood; however, it is involved in maintaining osmotic pressure, proper body hydration, and electric neutrality. In the absence of acid-base disturbances, chloride concentrations in plasma will generally follow those of sodium (Na+).
Since urine is the primary mode of elimination of ingested chloride, urinary chloride excretion during steady state conditions will reflect ingested chloride, which predominantly is in the form of sodium chloride (NaCl). However, under certain clinical conditions, the renal excretion of chloride may not reflect intake. For instance, during states of extracellular volume depletion, urine chloride (and sodium) excretion is reduced.
An indicator of fluid balance and acid-base homeostasis
Urine sodium and chloride excretion are similar and, under steady state conditions, both the urinary sodium and chloride excretion reflect the intake of sodium chloride (NaCl). During states of extracellular volume depletion, low values indicate appropriate renal reabsorption of these ions, whereas elevated values indicate inappropriate excretion (renal wasting). Urinary sodium and chloride excretion may be dissociated during metabolic alkalosis with volume depletion where urine sodium excretion may be high (due to renal excretion of NaHCO3) while urine chloride excretion remains appropriately low.
High urine values of other halide ions (eg, bromide, fluoride, iodide) may lead to falsely high readings on the chloride ion-selective electrode (ISE).
Interpret with other clinical data.
1. Tietz Textbook of Clinical Chemistry. Third edition. Edited by CA Burtis, ER Ashwood. Philadelphia, WB Saunders Co, 1999
2. Toffaletti J: Electrolytes. In Professional Practice in Clinical Chemistry: A Review. Edited by DR Dufour, N Rifai. Washington, AACC Press, 1993
3. Kamel KS, Ethier JH, Richardson RM, et al: Urine electrolytes and osmolality: when and how to use them. Am J Nephrol 1990;10:89-102