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Vitzthum H, Meyer-Schwesinger C, Ehmke H. Novel functions of the anion exchanger AE4 (SLC4A9). Pflugers Arch 2024; 476:555-564. [PMID: 38195948 PMCID: PMC11006790 DOI: 10.1007/s00424-023-02899-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/12/2023] [Accepted: 12/14/2023] [Indexed: 01/11/2024]
Abstract
The kidney plays a crucial role in acid-base homeostasis. In the distal nephron, α-intercalated cells contribute to urinary acid (H+) secretion and β-intercalated cells accomplish urinary base (HCO3-) secretion. β-intercalated cells regulate the acid base status through modulation of the apical Cl-/HCO3- exchanger pendrin (SLC26A4) activity. In this review, we summarize and discuss our current knowledge of the physiological role of the renal transporter AE4 (SLC4A9). The AE4, as cation-dependent Cl-/HCO3- exchanger, is exclusively expressed in the basolateral membrane of β-intercalated cells and is essential for the sensing of metabolic acid-base disturbances in mice, but not for renal sodium reabsorption and plasma volume control. Potential intracellular signaling pathways are discussed that might link basolateral acid-base sensing through the AE4 to apical pendrin activity.
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Affiliation(s)
- Helga Vitzthum
- Institute of Cellular and Integrative Physiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Catherine Meyer-Schwesinger
- Institute of Cellular and Integrative Physiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
| | - Heimo Ehmke
- Institute of Cellular and Integrative Physiology, Center for Experimental Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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Gu W, Zhou J, Peng Y, Cai H, Wang H, Wan W, Li H, Xu C, Chen L. Prognostic Significance of Serum Chloride Level Reduction in Patients with Chronic Heart Failure with Different Ejection Fractions. Int Heart J 2023; 64:700-707. [PMID: 37518352 DOI: 10.1536/ihj.22-734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
Little is known regarding the prognostic value of serum chloride in patients with chronic heart failure (CHF) with different ejection fractions. We sought to determine the postdischarge outcomes associated with lower serum chloride between different CHF types.We reviewed the medical records of 1221 consecutive patients with CHF admitted to the First Affiliated Hospital of Kunming Medical University from January 2017 to October 2021. After excluding patients with in-hospital death, missing follow-up data, missing serum chloride level data, or chronic dialysis therapy, 791 patients were included. Of these patients, 343 had heart failure with reduced ejection fraction (HFrEF; i.e., left ventricular ejection fraction (LVEF) < 40%), and 448 had heart failure with preserved ejection fraction (HFpEF) or heart failure with median ejection fraction (HFmrEF; HFpEF plus HFmrEF; i.e., LVEF ≥40%). Over a median follow-up of 750 days, 344 patients (43.5%) had all-cause mortality. In the univariate analysis, serum sodium and chloride were strongly associated with mortality in both HF subgroups (P < 0.0001). A multivariable model including both serum sodium and chloride showed the highly significant association between serum chloride and survival (P < 0.0001), whereas the association between serum sodium and mortality was not reported (HFpEF plus HFmrEF, hazard ratio (HR) 0.975, 95% confidence interval [CI] 0.942-1.010, P = 0.158; HFrEF, HR 1.007, 95% CI 0.966-1.051, P = 0.734). Kaplan-Meier survival curve analysis revealed a significant difference in mortality risk with decreasing chloride levels in all patients with CHF. The optimal cutoff value of chloride in predicting all-cause mortality was 102.95 mmol/L with area under the curve value of 0.76 [HR 0.760, 95% CI 0.727-0.793, P < 0.0001], sensitivity of 60.2%, and specificity of 78.3%.Lower serum chloride is an independent predictor of death in CHF, regardless of heart failure subtype.
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Affiliation(s)
- Wenyi Gu
- Kunming Medical University First Affiliated Hospital
| | - Jing Zhou
- Kunming Medical University First Affiliated Hospital
| | - Yunzhu Peng
- Kunming Medical University First Affiliated Hospital
| | - Hongyan Cai
- Kunming Medical University First Affiliated Hospital
| | - Huawei Wang
- Kunming Medical University First Affiliated Hospital
| | - Wen Wan
- Kunming Medical University First Affiliated Hospital
| | - Hongxia Li
- Kunming Medical University First Affiliated Hospital
| | - Chenggong Xu
- Kunming Medical University First Affiliated Hospital
| | - Lixing Chen
- Kunming Medical University First Affiliated Hospital
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Li X, Zhang X, Liu Y, Shu F, Shao S, Tan N, Jiang L. Relationship between serum chloride and prognosis in non-ischaemic dilated cardiomyopathy: a large retrospective cohort study. BMJ Open 2022; 12:e067061. [PMID: 36535716 PMCID: PMC9764625 DOI: 10.1136/bmjopen-2022-067061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES Serum chloride has a unique homeostatic role in modulating neurohormonal pathways. Some studies have reported that hypochloremia has potential prognostic value in cardiovascular diseases; thus, we aimed to investigate the association of baseline serum chloride with clinical outcomes in elderly patients with non-ischaemic dilated cardiomyopathy (NIDCM). DESIGN Retrospective study. SETTING AND PARTICIPANT A total of 1088 patients (age ≥60 years) diagnosed with NIDCM were enrolled from January 2010 to December 2019. RESULTS Logistic regression analyses showed that serum chloride was significantly associated with in-hospital death. Receiver operating characteristic (ROC) curve analyses showed that serum chloride had excellent prognostic ability for in-hospital and long-term death (area under the curve (AUC)=0.690 and AUC=0.710, respectively). Kaplan-Meier survival analysis showed that the patients with hypochloremia had worse prognoses than those without hypochloremia (log-rank χ2=56.69, p<0.001). After adjusting for age, serum calcium, serum sodium, left ventricular ejection fraction, lg NT-proBNP and use of diuretics, serum chloride remained an independent predictor of long-term death (HR 0.934, 95% CI 0.913 to 0.954, p<0.001). CONCLUSIONS Serum chloride concentration was a prognostic indicator in elderly patients with NIDCM, and hypochloremia was significantly associated with both in-hospital and long-term poor outcomes.
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Affiliation(s)
- Xinyi Li
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Xiaonan Zhang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Yaoxin Liu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Fen Shu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Sisi Shao
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Ning Tan
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
| | - Lei Jiang
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, South China University of Technology, Guangzhou, China
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Dyschloremia is associated with failure to restore renal function in survivors with acute kidney injury: an observation retrospective study. Sci Rep 2020; 10:19623. [PMID: 33184400 PMCID: PMC7661702 DOI: 10.1038/s41598-020-76798-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/23/2020] [Indexed: 01/30/2023] Open
Abstract
Dyschloremia is common in critically ill patients. However, little is known about the effects of dyschloremia on renal function in patients with acute kidney injury (AKI) requiring continuous renal replacement therapy (CRRT). A total of 483 patients who received CRRT for AKI were selected and divided into three groups according to their serum chloride concentrations at the time of CRRT initiation. At 90 days after initiating CRRT, renal outcome, i.e., non-complete renal recovery, or renal failure, was assessed in the three groups. The hypochloremia group (serum chloride concentrations < 96 mEq/L, n = 60), the normochloremia group (serum chloride concentrations, 96–111 mEq/L, n = 345), and the hyperchloremia group (serum chloride concentrations > 111 mEq/L, n = 78) were classified. The simplified acute physiology score III was higher in the hyperchloremia and hypochloremia groups than in the normochloremia group. Multivariate logistic regression analyses showed that hypochloremia (odds ratio, 5.12; 95% confidence interval [CI], 2.56–10.23; P < 0.001) and hyperchloremia (odds ratio, 2.53; 95% CI, 1.25–5.13; P = 0.01) were significantly associated with non-complete renal recovery. Similar trends were observed for renal failure. This study showed that dyschloremia was independently associated with failure in restoring renal function following AKI.
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Oi Y, Sato K, Nogaki A, Shinohara M, Matsumoto J, Abe T, Morimura N. Association between venous blood lactate levels and differences in quantitative capillary refill time. Acute Med Surg 2018; 5:321-328. [PMID: 30338077 PMCID: PMC6167399 DOI: 10.1002/ams2.348] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/27/2018] [Indexed: 01/01/2023] Open
Abstract
Aim Capillary refill time has been widely adopted for clinical assessment of the circulatory status of patients in emergency settings. We previously introduced quantitative capillary refill time and found a positive association between longer quantitative capillary refill time and higher lactate levels in the intensive care units, but not in the emergency department. In this study, we aimed to identify a quantitative and clinically applicable index of circulatory status (ΔA b) that can be measured with quantitative capillary refill time, then evaluated the linear association between this index and lactate levels in the emergency department. Methods We undertook a prospective single-center observational study at a university hospital from November 2015 to July 2016. We included 139 patients with endogenous diseases to test the association between quantitative capillary refill time, ΔA b (measured with a pulse oximeter), and lactate levels. Results ΔA b was independently and significantly associated with high lactate levels (odds ratio [95% confidence interval]: 0.16 [0.05-0.45]). Conclusions We introduced ΔA b, measured using quantitative capillary refill time, as a surrogate index of lactate levels to overcome the shortcomings of capillary refill time. We showed that ΔA b is a feasible, non-invasive, and rapid assessment of patients with high lactate levels in emergency primary care settings. Future multicenter studies with a longitudinal design should be undertaken to verify our findings.
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Affiliation(s)
- Yasufumi Oi
- Emergency Care Department Yokohama City University Hospital Yokohama Japan.,Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan
| | - Kosuke Sato
- Emergency Care Department Yokohama City University Hospital Yokohama Japan.,Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan
| | - Ayako Nogaki
- Emergency Care Department Yokohama City University Hospital Yokohama Japan.,Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan
| | - Mafumi Shinohara
- Emergency Care Department Yokohama City University Hospital Yokohama Japan.,Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan
| | - Jun Matsumoto
- Emergency Care Department Yokohama City University Hospital Yokohama Japan.,Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan
| | - Takeru Abe
- Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan.,Advanced Critical Care and Emergency Center Yokohama City University Medical Center Yokohama Japan
| | - Naoto Morimura
- Department of Emergency medicine Yokohama City University School of Medicine Yokohama Japan.,Department of Acute Medicine Graduate School of Medicine The University of Tokyo Tokyo Japan
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Grodin JL, Verbrugge FH, Ellis SG, Mullens W, Testani JM, Tang WHW. Importance of Abnormal Chloride Homeostasis in Stable Chronic Heart Failure. Circ Heart Fail 2016; 9:e002453. [PMID: 26721916 DOI: 10.1161/circheartfailure.115.002453] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The aim of this analysis was to determine the long-term prognostic value of lower serum chloride in patients with stable chronic heart failure. Electrolyte abnormalities are prevalent in patients with chronic heart failure. Little is known regarding the prognostic implications of lower serum chloride. METHODS AND RESULTS Serum chloride was measured in 1673 consecutively consented stable patients with a history of heart failure undergoing elective diagnostic coronary angiography. All patients were followed for 5-year all-cause mortality, and survival models were adjusted for variables that confounded the chloride-risk relationship. The average chloride level was 102 ± 4 mEq/L. Over 6772 person-years of follow-up, there were 547 deaths. Lower chloride (per standard deviation decrease) was associated with a higher adjusted risk of mortality (hazard ratio 1.29, 95% confidence interval 1.12-1.49; P < 0.001). Chloride levels net-reclassified risk in 10.4% (P = 0.03) when added to a multivariable model (with a resultant C-statistic of 0.70), in which sodium levels were not prognostic (P = 0.30). In comparison to those with above first quartile chloride (≥ 101 mEq/L) and sodium (≥ 138 meq/L), subjects with first quartile chloride had a higher adjusted mortality risk, whether they had first quartile sodium (hazard ratio 1.35, 95% confidence interval 1.08-1.69; P = 0.008) or higher (hazard ratio 1.43, 95% confidence interval 1.12-1.85; P = 0.005). However, subjects with first quartile sodium but above first quartile chloride had no association with mortality (P = 0.67). CONCLUSIONS Lower serum chloride levels are independently and incrementally associated with increased mortality risk in patients with chronic heart failure. A better understanding of the biological role of serum chloride is warranted.
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Affiliation(s)
- Justin L Grodin
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.)
| | - Frederik H Verbrugge
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.)
| | - Stephen G Ellis
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.)
| | - Wilfried Mullens
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.)
| | - Jeffrey M Testani
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.)
| | - W H Wilson Tang
- From the Department of Cardiovascular Medicine, Heart and Vascular Institute (J.L.G., S.G.E., W.H.W.T.) and Department for Cellular and Molecular Medicine, Lerner Research Institute (W.H.W.T.), Cleveland Clinic, OH; Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium (F.H.V., W.M.); and Program of Applied Translational Research, Yale University School of Medicine, New Haven, CT (J.M.T.).
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Sehgal V, Vijayan S, Yasmin S, Srirangalingam U, Pati J, Drake WM. Normocalcaemic tetany. Clin Med (Lond) 2011; 11:594-5. [PMID: 22268317 PMCID: PMC4952344 DOI: 10.7861/clinmedicine.11-6-594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- V Sehgal
- Department of Endocrinology, St Bartholomew's Hospital, London.
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Gilmour KM, Collier CL, Dey CJ, Perry SF. Roles of cortisol and carbonic anhydrase in acid-base compensation in rainbow trout, Oncorhynchus mykiss. J Comp Physiol B 2010; 181:501-15. [PMID: 21136263 DOI: 10.1007/s00360-010-0540-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 11/09/2010] [Accepted: 11/17/2010] [Indexed: 02/06/2023]
Abstract
Fish compensate for acid-base disturbances primarily by modulating the branchial excretion of acid-base equivalents, with a supporting role played by adjustment of urinary acid excretion. The present study used metabolic acid-base disturbances in rainbow trout, Oncorhynchus mykiss, to evaluate the role played by cortisol in stimulating compensatory responses. Trout infused with acid (an iso-osmotic solution of 70 mmol L(-1) HCl), base (140 mmol L(-1) NaHCO(3)) or saline (140 mmol L(-1) NaCl) for 24 h exhibited significant elevation of circulating cortisol concentrations. Acid infusion significantly increased both branchial (by 328 μmol kg(-1) h(-1)) and urinary (by 5.9 μmol kg(-1) h(-1)) net acid excretion, compensatory responses that were eliminated by pre-treatment of trout with the cortisol synthesis inhibitor metyrapone (2-methyl-1,2-di-3-pyridyl-1-propanone). The significant decrease in net acid excretion (equivalent to enhanced base excretion) of 203 μmol kg(-1) h(-1) detected in base-infused trout was unaffected by metyrapone treatment. Acid- and base-infusions also were associated with significant changes in the relative mRNA expression of branchial and renal cytosolic carbonic anhydrase (tCAc) and renal membrane-linked CA IV (tCA IV). Cortisol treatment caused changes in CA gene expression that tended to parallel those observed with acid but not base infusion. For example, significant increases in renal relative tCA IV mRNA expression were detected in both acid-infused (~2x) and cortisol-treated (~10x) trout, whereas tCA IV mRNA expression was significantly reduced (~5x) in base-infused fish. Despite changes in CA gene expression in acid- or base-infused fish, neither acid nor base infusion affected CAc protein levels in the gill, but both caused significant increases in branchial CA activity. Cortisol treatment similarly increased branchial CA activity in the absence of an effect on branchial CAc protein expression. Taken together, these findings provide support for the hypothesis that in rainbow trout, cortisol is involved in mediating acid-base compensatory responses to a metabolic acidosis, and that cortisol exerts its effects at least in part through modulation of CA.
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Affiliation(s)
- K M Gilmour
- Department of Biology, University of Ottawa, 30 Marie Curie, Ottawa, ON, K1N 6N5, Canada.
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Feldman M, Soni NJ, Dickson B. Use of sodium concentration and anion gap to improve correlation between serum chloride and bicarbonate concentrations. J Clin Lab Anal 2006; 20:154-9. [PMID: 16874811 PMCID: PMC6807406 DOI: 10.1002/jcla.20124] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Although most acid-base disorders cause opposite and equal changes in serum chloride and bicarbonate concentrations, this inverse relationship can be distorted by changes in the anion gap and/or water balance. Therefore, we examined the relationship between chloride and bicarbonate before and after adjusting for anion gap and serum sodium concentration. Patients with abnormal electrolytes were grouped by chloride and bicarbonate concentrations (low, normal, and high). Then, chloride and anion gap-adjusted bicarbonate were adjusted for water excess (or deficit), manifesting as hyponatremia (or hypernatremia), after which patients were reclassified. Classification by chloride and bicarbonate changed in 82% of the 135 patients after adjustment for anion gap and sodium. Serum chloride and bicarbonate were each low (concordant) in 23 patients, while 18 had discordant chlorides and bicarbonates (9 low/high, 9 high/low). After adjustments, chloride and bicarbonate were discordant in 40 patients (31 low/high, 9 high/low) and concordant in none. The correlation between serum chloride and bicarbonate improved from -0.459 to -0.998 after adjustments for sodium and anion gap. A very close inverse relationship between serum chloride and bicarbonate concentrations is commonly distorted by concomitant water disturbances and anion gap acidoses in internal medicine patients admitted with electrolyte disorders.
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Affiliation(s)
- Mark Feldman
- Department of Internal Medicine, Presbyterian Hospital of Dallas, Dallas, Texas 75231, USA.
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