All you need/want to know about chloride – at last

Compared with other plasma electrolytes, such as sodium, potassium and bicarbonate, chloride usually gets very limited coverage in medical texts. Now in a wide-ranging review article chloride gets the exclusive billing that its physio-pathological significance deserves. 

The article begins with consideration of the physiological importance of chloride for gastric acid production, maintaining the tonicity of extracellular fluid and the pH of blood. There follows a section dealing with physiological mechanisms involved in maintaining chloride balance, which includes considerable detail of renal handling of chloride and regulation of chloride urine loss; the kidneys are the principal route of chloride excretion. 

Most of the remainder of the article focuses on the clinical value of measuring plasma chloride concentration. The many causes of reduced plasma chloride (hypochloremia) and increased plasma chloride (hyperchloremia) are discussed. 

The particular diagnostic value of measuring chloride in metabolic acid-base disturbances is highlighted. Along with its 84 references this review provides a helpful resource for those with an interest in electrolyte and acid-base disorders.