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Chlorohydropenic (chloroprivine, hypochloremic) coma - Causes

Alexey Kryvenko, medical expert
Last reviewed: 04.07.2025

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Causes of development of hypochloremic coma

Persistent vomiting of any origin (decompensated pyloric stenosis of ulcerative or cancerous etiology; duodenal obstruction; Zollinger-Ellison syndrome - gastrin-producing tumor of the pancreas in combination with a non-healing and often aggravating ulcer of the gastroduodenal region; brain tumors; intractable vomiting of pregnancy; intestinal obstruction; poisoning; cholelithiasis; acute pancreatitis; kidney disease).
Uncontrollable diarrhea of any etiology (toxic infection, enteritis, Crohn's disease, sprue, severe gluten enteropathy, nonspecific ulcerative colitis, cholera and other intestinal infections, irrational use of laxatives).
Excessive diuresis due to excessive use of diuretics.
Repeated gastric lavage, frequent pleural punctures, paracentesis of the abdominal cavity with removal of a large amount of fluid.
Long-term salt-free diet.
Intense and prolonged sweating.
Adrenal insufficiency in the acute exacerbation phase.
Political phase of renal failure.

Pathogenesis

The above-mentioned etiologic factors lead to loss of water, chlorine, sodium, potassium. Severe dehydration, hypovolemia, and blood thickening develop. Electrolyte disturbances lead to development of metabolic (hypochloremic, hypokalemic) alkalosis. Alkalosis reduces the amount of ionized calcium in the blood. As a result of dehydration, hypovolemia, and metabolic alkalosis, blood supply to internal organs is disrupted. The kidneys suffer first of all - glomerular filtration decreases, oligoanuria develops. Long-term circulatory disorder in the kidneys leads to organic damage to the tubules. Along with this, there is increased breakdown of proteins and azotemia occurs.