Chloride (Cl) Test

Chloride is a type of electrolyte required by your body for proper functioning. Electrolytes are electrically charged minerals to help control the fluid balance and acid-base balance in your body.

Chloride is a negatively charged ion, which forms an important part of your body’s essential electrolytes. The four electrolytes sodium, potassium, bicarbonate and chloride work together to regulate the fluid balance in your body and maintain the acid-base balance. Chloride levels are usually measured along with other electrolytes in the body like sodium, potassium and bicarbonate to diagnose your medical condition or track the prognosis of your illness.

When your chloride levels drop, you may become sick and dehydrated. If your chloride levels go higher, your kidneys may not be functioning adequately. The diseases related to levels of chloride include kidney disease, high blood pressure and liver disease.

Chloride is present in all body fluids. This electrolyte is present in the highest concentrations in blood and in the fluid outside your body’s cells. Sodium and chloride go hand-in-hand and often mimic each other’s concentrations in the blood. Both these electrolytes increase and decrease due to similar causes. Chloride helps maintain electrical neutrality at the cellular level by in and out of the cells whenever needed.

Chloride is consumed through your daily diet and table salt. Most of the chloride from the food gets absorbed in the digestive tract and the excess of chloride is eliminated in urine. The blood levels of chloride usually remain steady, with a slight decrease in the levels after meals. This is because your stomach produces acids after you eat and uses the chloride from the blood.

The Chloride Test measures the levels of chloride in the blood and occasionally urine as well. It is often measured along with other electrolytes when you need to get a full blood workup of all your electrolytes.

The Chloride Test is used for the diagnosis of the causes of the signs and symptoms like diarrhoea, prolonged vomiting, weakness, fatigue and difficulty in breathing. If your doctor suspects an electrolyte imbalance, then you may be advised a series of electrolyte tests to diagnose and monitor your condition.

If your doctor suspects an acid-base imbalance, then you may be advised a series of tests for blood gases to diagnose and monitor the cause of the imbalance. The Chloride Test is also done when there may be suspected acidosis or alkalosis.

Studies show that electrolyte imbalance is markedly present in patients with uncontrolled blood sugar levels or diabetes. Therefore, the Chloride Test helps as a predictor and should be routinely measured in people with type 2 diabetes mellitus.

What are the symptoms of high chloride?

Symptoms of high chloride include -

• Fluid retention
• High blood pressure
• Numbness or tingling
• Muscle weakness
• Muscle spasms or twitching
• Confusion, difficulty in concentrating
• Personality changes
• Seizures and convulsions
• Irregular heart rate

Other names of chloride test

• Cl Test
• Serum Chloride Test

What does the chloride test measure? Who is the test prescribed for?

The Chloride Test measures the level of chloride in your blood. The Chloride Test helps measure chloride to diagnose conditions of the liver and kidneys based on these signs.

The Chloride Test can be prescribed for all age groups and genders. This test is prescribed in the following cases:

1. Symptoms of an acid-base imbalance

If you are experiencing any of the following symptoms, your doctor may advise you to get the Chloride Test done.

• Fatigue
• Vomiting
• Diarrhoea
• Weakness
• Dehydration
• Breathing difficulty

2. Monitor chronic conditions

If you have any of the following medical conditions, your doctor may advise the Chloride Test along with the electrolyte panel and blood gas panel.

• Heart diseases
• Kidney disorders
• High blood pressure (Hypertension)
• Diabetes
• High cholesterol levels (Dyslipidaemia)
• Liver disorders
• Nutritional issues

The Chloride Test results are usually reported in milliequivalents per litre (mEq/L) or millimoles per litre (mmol/L). If you have gotten the entire metabolic panel of tests done, you will get the reports of all parameters.

The Chloride Test results give you a report of the abnormal levels of chloride in the blood.

Normal Chloride Test ranges may vary depending on the laboratory.

Low chloride levels may lead to hypochloraemia. This is caused due to:

• Heart failure
• Lung diseases
• Addison’s disease - a condition in which your body’s adrenal glands do not produce enough of a specific type of hormone. This can cause weakness, dizziness, weight loss and dehydration.
• Diabetic ketoacidosis
• Aldosterone deficiency
• Metabolic alkalosis - a condition where you have too much base in your body that can cause muscle twitching, irritability and tingling in your fingers and toes.
• Prolonged vomiting or gastric suction
• Cushing syndrome - a condition where you have increased cortisol levels in your body that can cause weight gain, stretch marks on the skin, easy bruising on the skin, slow wound healing and acne.
• Malabsorption syndrome

High chloride levels can lead to hyperchloraemia. This is caused due to:

• Severe dehydration leads to loss of fluids in the body.
• Kidney diseases that result in electrolyte imbalance.
• Cushing syndrome - a condition where you have increased cortisol levels in your body that can cause weight gain, stretch marks on the skin, easy bruising on the skin, slow wound healing and acne.
• Metabolic acidosis - a condition where you have too much acid in your blood that can cause nausea, vomiting and fatigue.
• Metabolic alkalosis - a condition where you have too much base in your body that can cause muscle twitching, irritability and tingling in your fingers and toes.
• Chemotherapy leads to increased vomiting and dehydration, resulting in fluid loss and damage to the kidneys.

High levels of chloride are also caused due to the following medicines:

• Cortisone
• Oestrogen
• NSAIDs like ibuprofen, naproxen - medicines used to reduce inflammation
• Ammonium chloride
• Diuretics - medicines used to increase urine production
• Laxatives - medicines used to ease constipation and induce diarrhoea

The Chloride Test results may be inaccurate in the following cases -

• Drinking too much water
• Receiving a large number of intravenous fluids
• Loss of fluids due to excessive diarrhoea or vomiting

Based on your Chloride Test results, the doctor may require some other tests from the metabolic panel to confirm the clinical diagnosis.

The Chloride Test requires a sample of your blood. This test is usually combined with other regular tests.

Chloride test preparation

The Chloride Test takes a sample of your blood for testing. It does not require any special preparation. However, if you are getting other blood tests done along with the Chloride Test, you may need not eat or drink anything for 10-12 hours based on the tests.

a. Before the Chloride Test

This test does not require any preparation from your end. First, inform your physician about any medicines that you may be taking. Medications like cortisone, oestrogen, ammonium chloride and NSAIDs like ibuprofen, naproxen, etc., are known to increase chloride levels. You may have to stop taking these medicines before getting the test done or your doctor will interpret the results accordingly.

b. During the Chloride Test

It is a simple blood test that will get over in 5-10 minutes. You do not need to prepare for the test in any way.

c. After the Chloride Test

There are no restrictions after the Chloride Test. Therefore, you can resume regular activity after the test.

Test inclusions: What parameters are included in the chloride test?

The parameters included in the Chloride Test are the measures of the chloride levels in the blood. When you get the test done as part of your kidney function tests, it will consist of other values like electrolytes like sodium, potassium and bicarbonate, along with chloride levels.

How frequently should you take the chloride test?

Based on your diagnosis and symptoms, your doctor may repeat the Chloride Test as follows:

• If you have a chronic (long-term) condition like liver disease or kidney disease, the Chloride Test is repeated every 3-6 months/ as advised by your doctor.
• If you have an acute (severe) liver or kidney condition, then the Chloride Test may need to be repeated every other day to keep track of your illness.

Regular monitoring and testing allow your doctor to check the prognosis of your disease and how you are responding to the treatment. In addition, follow-up tests of the Chloride Test help provide detailed information about the severity of the disease and how the disease has progressed over time.

Electrolyte imbalance, Acid-base imbalance