Document Type: Original Article

Authors

1 Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2 Department of Emergency Medicine, Shohada-e Tajrish Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3 Department of Emergency Medicine, Qom University of Medical Sciences, Qom, Iran

4 Department of Emergency Medicine, Baqiyatallah University of Medical Sciences, Tehran, Iran

Abstract

Objective: Chloride is the major plasma anion. There are several methods available for the determination of serum chloride levels. Unfortunately these methods are sometimes not available in the urgent setting where values are needed. Here we describe a formula for estimating plasma chloride levels.
Methods: Fifty-two consecutive patients were enrolled for which serum chloride levels were estimated using the formula CL- = (Na+ + 10 –TBB), and also measured directly through the colorimetric method. Correlation between the two values was analyzed using Pearson correlation coefficient and agreement was shown in the Bland-Altman plot.
Results: Comparing the values achieved through estimation and laboratory determination of plasma chloride revealed a significant correlation (r = 0.97). Consistent agreement was described within -4.8 and +6.6 on the Bland-Altman plot throughout the measurements.
Conclusion: The formula presented here may be a reliable alternative to direct measurement of serum chloride when direct results are not available.

Keywords

Main Subjects

  1. Morisson G. Serum chloride. In: Walker HK, Hall WD, Hurst JW, eds. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd ed. Boston: Butterworths; 1990.
  2. Seifter JL. Integration of acid–base and electrolyte disorders. N Engl J Med 2014; 371(19): 1821-31. doi: 10.1056/NEJMra1215672.
  3. Funk GC, Doberer D, Heinze G, Madl C, Holzinger U, Schneeweiss B. Changes of serum chloride and metabolic acid-base state in critical illness. Anaesthesia 2004; 59(11): 1111-5. doi: 10.1111/j.1365-2044.2004.03901.x.
  4. Kimura S, Matsumoto S, Muto N, Yamanoi T, Higashi T, Nakamura K, et al. Association of serum chloride concentration with outcomes in postoperative critically ill patients: a retrospective observational study. J Intensive Care 2014; 2(1): 39. doi: 10.1186/2052-0492-2-39.
  5. McCallum L, Jeemon P, Hastie CE, Patel RK, Williamson C, Redzuan AM, et al. Serum chloride is an independent predictor of mortality in hypertensive patients. Hypertension 2013; 62(5): 836-43. doi: 10.1161/ HYPERTENSIONAHA.113.01793.
  6. Panteghini M, Bonora R, Malchiodi A, Calarco M. Evaluation of the direct potentiometric method for serum chloride determination--comparison with the most commonly employed methodologies. Clin Biochem 1986; 19(1): 20-5. doi: 10.1016/s0009-9120(86)80066-2.
  7. Parham H, Zargar B. Simultaneous coulometric determination of iodide, bromide and chloride in a mixture by automated coupling of constant current chronopotentiometry and square wave voltammetry. Analytica Chimica Acta 2002; 464(1): 115-22. doi: 10.1016/ s0003-2670(02)00379-3.
  8. Sekerka I, Lechner JF. Ion selective electrode for determination of chloride ion in biological materials, food products, soils and waste water. J Assoc Off Anal Chem 1978; 61(6): 1493-5.
  9. Tavallali H, Deilamy Rad G, Parhami A, Abbasiyan E. Colorimetric detection of copper and chloride in DMSO/H2O media using bromopyrogallol red as a chemosensor with analytical applications. Spectrochim Acta A Mol Biomol Spectrosc 2012; 97: 60-5. doi: 10.1016/j. saa.2012.05.071.
  10. Arai K, Kusu F, Noguchi N, Takamura K, Osawa H. Selective determination of chloride and bromide ions in serum by cyclic voltammetry. Anal Biochem 1996; 240(1): 109-13. doi: 10.1006/abio.1996.0336.
  11. Stewart PA. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol 1983; 61(12): 1444-61. doi: 10.1139/ y83-207.
  12.  Schoenfeld RG, Lewellen CJ. A colorimetric method for determination of serum chloride. Clin Chem 1964; 10: 533-9.
  13.  Rees SE, Toftegaard M, Andreassen S. A method for calculation of arterial acid-base and blood gas status from measurements in the peripheral venous blood. Comput Methods Programs Biomed 2006; 81(1): 18-25.
  14. Rink N, Zappitelli M. Estimation of glomerular filtration rate with and without height: effect of age and renal function level. Pediatr Nephrol 2015; 30(8): 1327-36. doi: 10.1007/s00467-015-3063-0.
  15.  Casado Cerrada J, Carrasco Sanchez FJ, Perez-Calvo JI, Manzano L, Formiga F, Aramburu Bodas O, et al. Prognostic value of glomerular filtration rate estimation equations in acute heart failure with preserved versus reduced ejection fraction. Int J Clin Pract 2015; 69(8): 829-39. doi: 10.1111/ ijcp.12616.