Chloride, 24 Hour, Urine
As an indicator of fluid balance and acid-base homeostasis
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
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.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
40-224 mmol/24 hours
Urine sodium and chloride excretion are similar and, under steady state conditions, both the urinary sodium and chloride excretion reflect the intake of 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.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
High urine values of other halide ions (eg, bromide, fluoride, iodide) may lead to falsely-high readings on the chloride ion-selective electrode.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Tietz Textbook of Clinical Chemistry. Third edition. Edited by CA Burtis, ER Ashwood. Philadelphia, WB Saunders Company, 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