chloride in adrenal insufficiency

Q: Patients with adrenal insufficiency tend to have? - select one

A) Hyperchloremia

B) Hypochloremia

Answer: A

Adrenal insufficiency, as defined by mineralocorticoid deficiency, causes hyperkalemia and hyperchloremic acidosis. 

Mechanism of action: The loss of aldosterone reduces hydrogen ion excretion in the renal collecting duct, leading to hyperchloremic normal anion gap metabolic acidosis. 

Other imbalances that may occur

• Hyponatremia 
• hypercalcemia (though rare)
• hypoglycemia

#electrolytes

#endocrinology

References:

1. Sagar N, Lohiya S. A Comprehensive Review of Chloride Management in Critically Ill Patients. Cureus. 2024 Mar 6;16(3):e55625. doi: 10.7759/cureus.55625. PMID: 38586759; PMCID: PMC10995984.

2. Kromah F, Tyroch A, McLean S, Hughes H, Flavin N, Lee S. Relative adrenal insufficiency in the critical care setting: debunking the classic myth. World J Surg. 2011 Aug;35(8):1818-23. doi: 10.1007/s00268-011-1126-3. PMID: 21533963; PMCID: PMC7101698.

3. Fries C, Fenske W. Elektrolytentgleisungen unter endokrinologischen Gesichtspunkten [An Endocrinological Perspective on Electrolyte Imbalances]. Dtsch Med Wochenschr. 2025 Aug;150(15):883-889. German. doi: 10.1055/a-2318-7580. Epub 2025 Jul 21. PMID: 40690933.