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CHLORIDE
MATERIALS REQUIRED BUT NOT SUPPLIED
Interferences
no interference was observed by the presence of: Current laboratory instrumentation. Spectrophotometer UV/VIS with thermostatic cuvette holder. Automatic micro- pipettes. Glass or high quality polystyrene cuvettes. Deio- Precision
REAGENT PREPARATION
SUMMARY OF TEST
intra-assay (n=10) mean (mEq/l) SD (mEq/l) Chloride is the major extracellular anion. Sodium and chlo- Stability: up to expiration date on labels at 15-25°C.
ride together represent the majority of the osmotically Stability since first opening of vials: ≥ 60 days at 15-25°C.
active constituents of plasma. Chloride is therefore signifi- inter-assay (n=20) mean (mEq/l) SD (mEq/l) cantly involved in maintenance of water distribution, osmo- PRECAUTIONS
tic pressure and anion-cation balance in the extracellular fluid compartment. In both gastric and small and large inte- Reagent may contain some non-reactive and preservative stinal secretions, Cl- is the most abundant anion.
components. It is suggested to handle carefully it, avoiding Methods comparison
Chloride ions in food are almost completely absorbed from a comparison between Chema and a commercially availa- the intestinal tract. They are filtered from plasma at the glo- Perform the test according to the general “Good Labora- meruli and passively reabsorbed, along with Na+, in the proximal tubules. In the thick ascending limb of the loop SPECIMEN
- is actively reabsorbed by the so-called “chlo- ride pump,” whose action promotes reabsorption of Na+ Serum, plasma heparinate. Separation of cells from plasma as well. Loop diuretics such as furosemide and ethacrynic should be prompt. Sweat is a suitable sample.
acid inhibit the chloride pump. Surplus Cl- is excreted in the urine and is also lost in the sweat. Excessive losses in Dilute sample urine 1:2 with redistilled water and multiply sweat, as can occur in hot weather, are normally minimized WASTE DISPOSAL
by the action of aldosterone, which is secreted by the adre- This product is made to be used in professional laborato- nal cortex in response to decrease in plasma Na+ and Cl-.
TEST PROCEDURE
ries. Please consult local regulations for a correct waste Hypochloremia is observed in salt-losing nephritis as asso- ciated with chronic pyelonephritis. In Addison’s disease, S56: dispose of this material and its container at hazar- Cl- levels are usually maintained close to normal except in dous or special waste collection point.
Addisonian crisis, when Cl- as well as Na+ levels may drop S57: use appropriate container to avoid environmental significantly. Hypochloremia may also be seen in those types of metabolic acidoses that are caused by increased S61: avoid release in environment. Refer to special instruc- production or diminished excretion of organic acids (e.g., diabetic ketoacidosis and renal failure). Persistent gastric secretion and prolonged vomiting, whatever the cause, REFERENCES
result in significant loss of Cl-, and ultimately in hypochlore- mia and depletion of total body Cl-. Other conditions asso- Levinson S.S., Direct determination of serum chloride with ciated with hypochloremia include aldosteronism, bromide a semiautomated discrete analyzer, Clin.Chem. 22:273- intoxication, cerebral salt-wasting after head injury, SIADH, Mix, incubate at 25, 30 or 37°C for 5 minutes.
and conditions associated with expansion of extracellular Tietz Textbook of Clinical Chemistry, Second Edition, Read absorbances of standard (As) and samples (Ax) fluid volume. In metabolic alkalosis, plasma levels of Cl- tend to fall while HCO - levels increase.
Hyperchloremia occurs with dehydration, renal tubular aci- MANUFACTURER
RESULTS CALCULATION
dosis, acute renal failure, metabolic acidosis associated with prolonged diarrhea and loss of sodium bicarbonate, in diabetes insipidus, in adrenocortical hyperfunction, and in salicylate intoxication. A slight rise in Cl- level is seen chloride mEq/l = Ax/As x 100 (standard value) in respiratory alkalosis. Hyperchloremic acidosis may be a sign of severe renal tubular pathology. Extremely high die- tary intake of salt and overtreatment with saline solutions chloride mEq/l = Ax/As x 100 x 2 (standard value and dilu- In a study of individuals with hypercalcemia due to either primary hyperparathyroidism or other causes, plasma Cl- concentrations were 106 ± 5 mmol/l for cases of primary hyperparathyroidism compared with 103 ± 3 mmol/l for the other group. The difference in Cl- levels was believed to be chloride mEq/24h = Ax/As x 100 x 2 x urine volume due to the effect of parathyroid hormone on distal tubular (standard value, dilution factor and diuresis in decilitres) EXPECTED VALUES
intake; physiological increase occurs with postmenstrual diuresis and decrease with premenstrual salt and water retention, in parallel with increase and decrease of urinary Na+ level. Massive diuresis of any cause is accompanied by increased Cl- excretion, as is K+ depletion and adrenocor- tical insufficiency. Urinary excretion of Cl- decreases when Each laboratory should establish appropriate reference losses by other routes are increased, as well as in adre- intervals related to its population.
nocortical hyperfunction and in postoperative stress syn- QUALITY CONTROL AND CALIBRATION
Spectrophotometric methods based on the reaction of chloride ions with HgCNS have been implemented on a It is suggested to perform an internal quality control. For this purpose the following human based control sera are PRINCIPLE OF THE METHOD
QN 0050 CH
QUANTINORM CHEMA 10 x 5 ml
Chloride ions react with mercuric ions, giving available an with normal or close to normal control values equal quantity of tiocyanate ions. Tiocyanate ions react QP 0050 CH
QUANTIPATH CHEMA 10 x 5 ml
with trivalent ferric ions present in solution to form a red colored complex with an absorbance peak at 480 nm.
If required, a multiparametric, human based calibrator is KIT COMPONENTS
AT 0030 CH
AUTOCAL H
For in vitro diagnostic use only.
Please contact Customer Care for further information.
The components of the kit are stable until expiration date TEST PERFORMANCE
Keep away from direct light sources.
Linearity
Reagent A
0100: 2 x 50 ml (liquid) blue cap
0500: 4 x 125 ml (liquid) blue cap
If the limit value is exceeded, it is suggested to dilute Composition: mercury(II) tiocyanate 2.2 mM, mercury(II) sample 1+9 with distilled water and to repeat the test, mul- chloride 0.7 mM, iron (III) nitrate 19 mM.
Standard:
chloride solution 100 mEq/l - 5 ml
Sensitivity/limit of detection (LOD)
the limit of detection is 1.5 mEq/l.

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