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Chlorohydropenic (chloroprivative, hypochloremic) coma: causes

Alexey Portnov, medical expert
Last reviewed: 20.11.2021

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Causes of hypochloraemic coma

Persistent vomiting of any origin (decompensated stenosis of the pyloric ulcer or cancer etiology, duodenal obstruction, Zollinger-Elisson syndrome-gastrin-producing pancreatic tumor in combination with the non-healing and often escalating ulcer of the gastroduodenal region, brain tumors, vomiting of pregnant women, intestinal obstruction, poisoning, cholelithiasis acute pancreatitis, kidney disease).
Indomitable diarrhea of any etiology (toxicoinfection, enteritis, Crohn's disease, sprue, severe degree of gluten enteropathy, ulcerative colitis, cholera and other intestinal infections, irrational use of laxatives).
Excessive diuresis with excessive use of diuretics.
Repeated gastric lavage, frequent pleural punctures, abdominal paracentesis with the removal of a large amount of fluid.
Prolonged salt-free diet.
Intensive and prolonged perspiration.
Adrenal insufficiency in the phase of acute exacerbation.
Political phase of renal failure.

Pathogenesis

The aforementioned etiological factors result in the loss of water, chlorine, sodium, and potassium. Deep dehydration, hypovolemia, thickening of blood develop. Electrolyte disorders lead to the development of metabolic (hypochloraemic, hypokalemic) alkalosis. Alkalosis reduces the amount of ionized calcium in the blood. Due to dehydration, hypovolemia, metabolic alkalosis, blood supply to internal organs is impaired. First of all, kidneys suffer - glomerular filtration decreases, oligoanuria develops. Long-term disturbance of blood circulation in the kidneys leads to organic damage to the tubules. Along with this, there is an increased disintegration of proteins and azotemia occurs.