Authors: Dr. Payal Bhandari, M.D., Hailey Chin

Contributors: Vivi Chador

Key Insights

Chloride (Cl-) is important for fluid balance, blood pressure, and nerve and muscle function. Monitoring chloride levels in the blood helps identify health issues related to high or low chloride. Abnormal levels can cause symptoms by disrupting acid-base balance, fluid balance, and organ function. Regular testing of chloride levels helps find the cause of many health problems and guide treatment. Adjusting diet, lifestyle, and medications can help manage abnormal chloride levels and improve overall health.

What is Chloride?

Chloride is an important electrolyte that helps with nerve function, muscle function, and fluid balance. It makes up about 70% of the anions (negatively charged ions) outside cells, mostly in the blood. Chloride works with sodium to help control blood pressure and ensure fluids are balanced throughout the body. It keeps cells hydrated and helps transport nutrients efficiently. In the kidneys, chloride helps reabsorb fluids and electrolytes. It also supports blood vessel function and the removal of waste. Chloride is key for nerve and brain function. It helps regulate electrical signals in nerve cells, controlling communication between cells. Proper chloride levels also support muscle function by helping maintain the electrical balance needed for muscle contractions.

Figure 1: The sodium-potassium pump moves sodium and potassium ions in and out of cells, using energy from ATP. This helps maintain ion balance, which is important for energy, muscle function, nerve signals, and cell health. Other pumps regulate calcium, magnesium, and chloride to control muscle contractions, cell signaling, and osmotic pressure, keeping cells working properly.

Figure 2: Chloride helps balance fluids, regulate blood pressure, and support nerve signals and muscle movements. It also maintains acid-base balance in the body. Proper chloride levels are essential for cell function and overall health.

Regulation of Chloride Levels in the Body

Chloride balance is controlled by hormones and processes in the kidneys, small intestines, and other tissues. These systems adjust chloride levels in urine, sweat, and stool to keep electrolyte levels balanced. Proper chloride regulation is important for maintaining fluid balance, healthy blood flow, and the body’s energy production. Chloride is mainly found in table salt, processed foods, animal products, and plant sources like leafy greens, tomatoes, whole grains, and olives.

Figure 3: Common sources of chloride include table salt, sea salt, animal products, canned foods, condiments, seaweed, vegetables, tomatoes, olives, legumes, cocoa, and whole grains. Foods like tomatoes, lettuce, celery, olives, kelp, and rye are especially rich in chloride. These foods also provide other important nutrients, making them key parts of a healthy diet.

Chloride is absorbed in the small intestine, enters the bloodstream, and is reabsorbed by the kidneys. The kidneys filter 3,905 to 8,875 mg daily, reabsorbing 99% and excreting about 6,390 mg in urine. Chloride helps balance electrolytes, blood pressure, and acid-base levels. Most reabsorption occurs in the proximal tubules (60-70%) and loop of Henle (20-30%).

Figure 4: Chloride absorption primarily occurs in the small intestine. Once released into the bloodstream, chloride is filtered and reabsorbed by the kidneys. A small percentage is stored in the bones and skeletal muscles. Unused chloride is excreted primarily in the urine and, to a lesser extent, via stool and sweat. 

The body uses the renin-angiotensin-aldosterone system (RAAS) and other hormones to regulate chloride levels. When chloride drops, the hormone aldosterone helps the body keep sodium and chloride balanced. If chloride rises, the heart releases atrial natriuretic peptide (ANP), which helps the kidneys get rid of excess chloride and water, lowering blood pressure.

Long-term imbalances in chloride can interfere with the RAAS system and ANP production, leading to high blood pressure and problems with fluid, acid-base, and electrolyte balance. This can damage organs, blood vessels, and tissues, affecting nerve and muscle function, energy balance, and overall body stability.

Pathophysiology Behind Abnormal Blood Chloride Levels 

Hyperchloremia is when chloride levels in the blood are higher than normal. Dehydration pulls water out of cells, raising chloride levels outside the cells (hypertonic state), causing cells to shrink. On the other hand, low chloride levels (hypochloremia) cause water to move into cells (hypotonic state), making them swell. Both conditions disrupt the balance of body fluids, affecting normal cell function.

Figure 5:Osmosis is the movement of water in and out of cells based on solute concentration. In hypotonic cells, more solutes are inside, so water moves in. In isotonic cells, water moves in and out equally because solute concentrations are the same. In hypertonic cells, fewer solutes are inside, so water moves out.

Dehydration can happen due to burns, diarrhea, excessive use of diuretics, heavy exercise, low water intake, blood loss, or conditions like ulcers and inflammation. When chloride levels are off, the body reacts by releasing hormones that either increase or decrease water and electrolyte balance. This can lead to high blood pressure, reduced blood flow, and damage to organs.

Chronic dehydration and imbalances can lead to problems like poor digestion, weak bones, and oxidative stress. This stress causes toxic byproducts to build up in the blood, leading to artery damage, increased cholesterol, and a higher risk of heart disease. It can also cause blood flow issues, resulting in muscle cramps, weakness, and poor coordination.

If dehydration and these imbalances are not treated, the body may prioritize vital organs, like the heart and brain, over non-vital ones like the skin and digestive tract. This worsens metabolism, increasing fat storage and raising the risk for autoimmune diseases like rheumatoid arthritis, diabetes, and inflammatory bowel disease.

Figure 6: Healthy gut microbiota plays a crucial role in maintaining overall metabolic and energy balance. A well-balanced microbiota supports food digestion, the absorption and transportation of nutrients, and waste excretion. In contrast, dysbiosis refers to a reduction in the concentration and variety of healthy bacteria. This imbalance can dysregulate metabolic pathways, reduce energy production, and mount an inflammatory response that increases the concentration of pathogens (such as viruses, fungi, and harmful bacteria), proinflammatory proteins, reactive oxygen species, and atherogenic cholesterol in the bloodstream. 

Figure 7: Atherosclerosis is when arteries harden and thicken due to fat and scar tissue (plaque) buildup. This blocks blood flow, raises blood pressure, and damages nearby tissues with heat and inflammatory proteins. Over time, it can cause blood to back up into organs like the heart, pancreas, and spleen, making them larger and less functional.

Chronic dehydration and inflammation also increase the risk of infections and certain cancers, leading to a shorter, lower-quality life. Studies show a higher risk of death in people with rheumatoid arthritis or diabetes who also have cardiovascular problems.

Figure 8: Imbalanced chloride and fluid levels weaken the immune system, leading to inflammation, infections, and cancer. Tumor cells and pathogens use free iron from damaged cells to grow and spread. Neutrophils protect blood vessels but block natural killer (NK) cells from destroying these harmful cells. Tumor cells also activate platelets and help form new blood vessels. Meanwhile, cytokines released by white blood cells allow pathogens to release toxins, damage red blood cells, steal nutrients like iron and oxygen, and promote tumor growth and infection.

Clinical Significance of Abnormal Chloride Levels

Figure 9: Abnormal chloride blood levels dysregulate fluid and electrolyte balance, and blood pressure, and cause dysfunction and potentially permanent damage across multiple organ systems.

Abnormal blood chloride levels can disrupt the balance of fluids and other electrolytes like sodium, calcium, and magnesium. This affects energy production, muscle function, and nerve communication, impacting several body systems:

1. Nervous System (CNS): Imbalanced chloride can cause brain swelling or shrinkage, confusion, seizures, coma, or death by disrupting nerve signaling.

2. Digestive System (GI): It can damage gut bacteria, impair digestion, and reduce nutrient absorption, causing nausea, vomiting, pain, and constipation.

3. Muscle and Bones (MSK): Low chloride weakens bones, joints, and muscles, leading to cramps, arthritis, fractures, and poor healing.

4. Urinary System (GU): It increases water and mineral loss through urine, causing frequent urination, infections, and adrenal gland stress, which reduces key hormones like cortisol and aldosterone.

5. Heart and Blood Vessels (CVS): It can cause high or low blood pressure, irregular heartbeats, fatigue, and an increased risk of heart attacks, strokes, or organ failure.

Balanced chloride is essential for energy, strength, and overall health.

Prevalence and Statistics of Abnormal Blood Chloride Levels

Abnormal blood chloride levels, whether too high (hyperchloremia) or too low (hypochloremia), can disrupt normal body functions and strain organs like the kidneys, heart, and liver. A study of 49,025 heart patients in China found that 4.4% had low chloride levels. Over 5.2 years, 13.2% of those with hypochloremia died due to organ failure, nearly doubling their 30-day death risk and increasing long-term mortality by 32%. Another study of 1,940 ICU patients showed that 31.7% had high chloride levels. This group had a higher death rate (23.9% vs. 21.4%), needed more blood pressure support and transfusions, and stayed longer in the ICU.

Conclusion

Chloride is essential for fluid balance, blood pressure, digestion, and muscle and nerve function. High or low chloride levels can cause symptoms like muscle weakness, breathing problems, confusion, or irregular heartbeat. Imbalances also affect the body’s acid-base balance and energy production, leading to serious health risks like metabolic disorders and organ failure. Managing chloride levels may involve eating fewer processed foods, drinking more water with electrolytes, eating fresh plant-based foods, reducing stress, and monitoring medications. Keeping chloride levels balanced is key to staying healthy and preventing severe health problems.

Source References and Supplemental Research

1.  Raut SK, Singh K, Sanghvi S, et al. Chloride ions in health and disease. Biosci Rep. 2024;44(5):BSR20240029. doi:10.1042/BSR20240029 [PubMed]

2.  Berend K, van Hulsteijn LH, Gans RO. Chloride: the queen of electrolytes?. Eur J Intern Med. 2012;23(3):203-211. doi:10.1016/j.ejim.2011.11.013 [PubMed] [Elsevier]

3.  Rahmati N, Hoebeek FE, Peter S, De Zeeuw CI. Chloride Homeostasis in Neurons With Special Emphasis on the Olivocerebellar System: Differential Roles for Transporters and Channels. Front Cell Neurosci. 2018;12:101. Published 2018 May 1. doi:10.3389/fncel.2018.00101 [PubMed]

4. Kuo IY, Ehrlich BE. Signaling in muscle contraction. Cold Spring Harb Perspect Biol. 2015;7(2):a006023. Published 2015 Feb 2. doi:10.1101/cshperspect.a006023 [PubMed]

5.  Pirahanchi Y, Jessu R, Aeddula NR. Physiology, Sodium Potassium Pump. [Updated 2023 Mar 13]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [NIH] 

6.  Chloride in diet Information | Mount Sinai – New York. Mount Sinai Health System. [Mount Sinai] 

7.  Chloride – Urine. ucsfhealth.org. [UCSf Health] 

8.  Kataoka H. The “chloride theory”, a unifying hypothesis for renal handling and body fluid distribution in heart failure pathophysiology. Medical Hypotheses. 2017;104:170-173. doi:https://doi.org/10.1016/j.mehy.2017.06.005 [Elsevier]

9.  Ogawa H, Qiu Y, Philo JS, Arakawa T, Ogata CM, Misono KS. Reversibly bound chloride in the atrial natriuretic peptide receptor hormone-binding domain: possible allosteric regulation and a conserved structural motif for the chloride-binding site. Protein Sci. 2010;19(3):544-557. doi:10.1002/pro.332 [PubMed] [Wiley] [Full Text]

10.   Ramsay DJ. Homeostatic control of water balance. In: Arnaud MJ, editor. Hydration Throughout Life. Montrouge: John Libbey Eurotext; 1998. pp. 9–18. [Google Scholar]

11.  Chung J, Chen C, Paw BH. Heme metabolism and erythropoiesis. Curr Opin Hematol. 2012;19(3):156-162. doi:10.1097/MOH.0b013e328351c48b [PubMed] [Full Text] [PMC]

12.  Kotchen TA, Welch WJ, Lorenz JN, Ott CE. Renal tubular chloride and renin release. J Lab Clin Med. 1987;110(5):533-540. [PubMed]

13.  Kastl AJ Jr, Terry NA, Wu GD, Albenberg LG.The Structure and Function of the Human Small Intestinal Microbiota: Current Understanding and Future Directions. [ScienceDirect]. Accessed July 21, 2024.

14.  Wu G. Amino acids: metabolism, functions, and nutrition. Amino Acids. 2009;37(1):1-17. doi:10.1007/s00726-009-0269-0 [Pubmed][Crossref]

15.  Jakubowski H., Flatt P. Metabolic Fates of Amino Groups. LibreTexts Biology. [LibreTexts] 

16.  Liu, H., Huang, Y., Huang, M. et al. From nitrate to NO: potential effects of nitrate-reducing bacteria on systemic health and disease. Eur J Med Res 28, 425 (2023). https://doi.org/10.1186/s40001-023-01413-y [BMC]

17.  Bryan, N.S., Petrosino, J.F. (2017). Nitrate-Reducing Oral Bacteria: Linking Oral and Systemic Health. In: Bryan, N., Loscalzo, J. (eds) Nitrite and Nitrate in Human Health and Disease. Nutrition and Health. Humana Press, Cham. https://doi.org/10.1007/978-3-319-46189-2_3 [Springer]

18.  Kitamura K, Yamazaki J. Chloride channels and their functional roles in smooth muscle tone in the vasculature. Jpn J Pharmacol. 2001;85(4):351-357. doi:10.1254/jjp.85.351 [PubMed] [Full Text]

19. Song Y, Liu J, Zhao K, Gao L, Zhao J. Cholesterol-induced toxicity: An integrated view of the role of cholesterol in multiple diseases. Cell Metabolism. 2021;33(10):1911-1925. doi:10.1016/j.cmet.2021.09.001 [Elsevier]

20.  Della Corte V, Todaro F, Cataldi M, Tuttolomondo A. Atherosclerosis and Its Related Laboratory Biomarkers. Int J Mol Sci. 2023;24(21):15546. Published 2023 Oct 24. doi:10.3390/ijms242115546 [PMC Full Text] 

21.  Michel JB, Martin-Ventura JL. Red Blood Cells and Hemoglobin in Human Atherosclerosis and Related Arterial Diseases. Int J Mol Sci. 2020;21(18):6756. Published 2020 Sep 15. doi:10.3390/ijms21186756 [PMC Full Text] 

22.  Adiels M, Olofsson SO, Taskinen MR, Borén J. Overproduction of very low-density lipoproteins is the hallmark of the dyslipidemia in the metabolic syndrome. Arterioscler Thromb Vasc Biol. 2008;28(7):1225-1236. doi:10.1161/ATVBAHA.107.160192 [PubMed] [Full Text] [AHA Journals]

23.  Goto K, Kitazono T. Chloride Ions, Vascular Function and Hypertension. Biomedicines. 2022;10(9):2316. Published 2022 Sep 18. doi:10.3390/biomedicines10092316 [PubMed]

24.   Wilson J.G., Lindquist J.H., Grambow S.C., Crook E.D., Maher J.F. Potential role of increased iron stores in diabetes. Am. J. Med. Sci. 2003;325:332–339. doi: 10.1097/00000441-200306000-00004. [PubMed] [CrossRef] [Google Scholar]

25.  Tiedge M., Lortz S., Drinkgern J., Lenzen S. Relation between antioxidant enzyme gene expression and antioxidative defense status of insulin-producing cells. Diabetes. 1997;46:1733–1742. doi: 10.2337/diab.46.11.1733. [PubMed] [CrossRef] [Google Scholar]

26.  Crawford JH, Chacko BK, Kevil CG, Patel RP. The red blood cell and vascular function in health and disease. Antioxidants & redox signaling. 2004;6(6):992–999. [PubMed] [Google Scholar] 

27.  Conigliaro, P., Chimenti, Triggianese, P., Sunzini, F., Novelli, L., Perricone, C., & Perricone, R. (2016). Autoantibodies in inflammatory arthritis. Autoimmunity Reviews, 15(7), 673–683. https://doi.org/10.1016/j.autrev.2016.03.003 [Science Direct]

28.  Feingold, K. R., & Grunfeld, C. (2022, March 7). The effect of inflammation and infection on lipids and lipoproteins. Endotext – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK326741/ [NIH]

29.  Mrabet, S., Wafa, M., & Giovannoni, G. (2022). Multiple sclerosis and migraine: Links, management and implications. Multiple Sclerosis and Related Disorders, 68, 104152. https://doi.org/10.1016/j.msard.2022.104152 [Science Direct]

30.  Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum. 2008;59:1690–1697. [PubMed] [Reference list]

31.  Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Torp-Pedersen C, Hansen PR. The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis. 2011;70:929–934. [PubMed] [Reference list]

32.  Chen, L., Deng, H., Cui, H., Fang, J., Zuo, Z., Deng, J., Li, Y., Wang, X., & Zhao, L. (2017). Inflammatory responses and inflammation-associated diseases in organs. Oncotarget, 9(6), 7204–7218. [Oncotarget] [Crosslink] 

33.  Setién-Suero E, Suárez-Pinilla M, Suárez-Pinilla P, Benedicto Crespo-Facorro, Ayesa-Arriola R. Homocysteine and cognition: A systematic review of 111 studies. 2016;69:280-298. doi:https://doi.org/10.1016/j.neubiorev.2016.08.014 [Elsevier]

34.  Perna AF, Ingrosso D. Atherosclerosis determinants in renal disease: how much is homocysteine involved?. Nephrol Dial Transplant. 2016;31(6):860-863. doi:10.1093/ndt/gfv409 [PubMed] [Oxford Academic]

35.  Schaffer A, Verdoia M, Cassetti E, et al. Relationship between homocysteine and coronary artery disease. Results from a large prospective cohort study. Thromb Res. 2014;134(2):288-293. doi:10.1016/j.thromres.2014.05.025 [PubMed] [Elsevier]

36.  Hom J, Dulmovits BM, Mohandas N, Blanc L. The erythroblastic island as an emerging paradigm in the anemia of inflammation. Immunol Res. 2015;63(1-3):75-89. doi:10.1007/s12026-015-8697-2 [PubMed]

37.  Giuliani C, Peri A. Effects of Hyponatremia on the Brain. J Clin Med. 2014;3(4):1163-1177. Published 2014 Oct 28. doi:10.3390/jcm3041163 [PubMed]

38. Fahlke C. Chloride channels take center stage in a muscular drama. J Gen Physiol. 2011;137(1):17-19. doi:10.1085/jgp.201010574 [PubMed]

39.  Verbalis JG, Barsony J, Sugimura Y, et al. Hyponatremia-induced osteoporosis. J Bone Miner Res. 2010;25(3):554-563. doi:10.1359/jbmr.090827 [PubMed] 

40. Yasir M, Mechanic OJ. Syndrome of Inappropriate Antidiuretic Hormone Secretion. [Updated 2023 Mar 6]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [PubMed] 

41.  Dutt M, Wehrle CJ, Jialal I. Physiology, Adrenal Gland. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: [PubMed]

42.  Huang H, Mai Z, Chen L, et al. Prevalence and Mortality of Hypochloremia Among Patients with Coronary Artery Disease: A Cohort Study. Risk Manag Healthc Policy. 2021;14:3137-3145. Published 2021 Jul 27. doi:10.2147/RMHP.S306125 [PubMed]

43.  Shad ZS, Qureshi MSS, Qadeer A, et al. Hyperchloremia in Intensive Care Unit Mortality: An Underestimated Fact. Cureus. 2019;11(5):e4770. Published 2019 May 28. doi:10.7759/cureus.4770 [PubMed]

44.  Shi H, Su X, Li C, Guo W, Wang L. Effect of a low-salt diet on chronic kidney disease outcomes: a systematic review and meta-analysis. BMJ Open. 2022;12(1):e050843. Published 2022 Jan 11. doi:10.1136/bmjopen-2021-050843 [PubMed]

45.  Frida Emanuelsson, Børge G Nordestgaard, Marianne Benn, Familial Hypercholesterolemia and Risk of Peripheral Arterial Disease and Chronic Kidney Disease, The Journal of Clinical Endocrinology & Metabolism, Volume 103, Issue 12, December 2018, Pages 4491–4500, https://doi.org/10.1210/jc.2018-01058 [Oxford Academic]

46.  Gai, Z., Wang, T., Visentin, M., Kullak-Ublick, G., Fu, X., & Wang, Z. (2019). Lipid accumulation and chronic kidney disease. Nutrients, 11(4), 722. https://doi.org/10.3390/nu11040722 [PubMed]

47.  Lee, S., & Ho, K. (1978). Cholesterol fatty kidney: Morphological changes in the course of its development in rabbits. Experimental and Molecular Pathology, 29(3), 412–425. https://doi.org/10.1016/0014-4800(78)90082-5 [ScienceDirect] 

48.  Liang, X., Ye, M., Tao, M., Zheng, D., Cai, R., Zhu, Y., Jin, J., & He, Q. (2020). The association between dyslipidemia and the incidence of chronic kidney disease in the general Zhejiang population: a retrospective study. BMC Nephrology, 21(1). https://doi.org/10.1186/s12882-020-01907-5 [PubMed]

49.  Zarantonello D, Brunori G. The Role of Plant-Based Diets in Preventing and Mitigating Chronic Kidney Disease: More Light than Shadows. J Clin Med. 2023;12(19):6137. Published 2023 Sep 22. doi:10.3390/jcm12196137 [PubMed]

50.  Jardine MA, Kahleova H, Levin SM, Ali Z, Trapp CB, Barnard ND. Perspective: Plant-Based Eating Pattern for Type 2 Diabetes Prevention and Treatment: Efficacy, Mechanisms, and Practical Considerations. Adv Nutr. 2021;12(6):2045-2055. doi:10.1093/advances/nmab063 [PubMed]

51. Arumugham VB, Shahin MH. Therapeutic Uses of Diuretic Agents. [Updated 2023 May 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. [PubMed] 

52. Kennedy M. How much water you’re actually supposed to drink each day – and why 8 cups isn’t right for everyone. Business Insider. December 14, 2021. [Website] 

53.  Veniamakis E, Kaplanis G, Voulgaris P, Nikolaidis PT. Effects of Sodium Intake on Health and Performance in Endurance and Ultra-Endurance Sports. Int J Environ Res Public Health. 2022;19(6):3651. Published 2022 Mar 19. doi:10.3390/ijerph19063651 [PubMed]

54.  Dmitrieva NI, Burg MB. Elevated sodium and dehydration stimulate inflammatory signaling in endothelial cells and promote atherosclerosis. PLoS One. 2015;10(6):e0128870. Published 2015 Jun 4. doi:10.1371/journal.pone.0128870 [PubMed]

55.  Sterns RH, Thomas DJ, Herndon RM. Brain dehydration and neurologic deterioration after rapid correction of hyponatremia. Kidney Int. 1989;35(1):69-75. doi:10.1038/ki.1989.9 [PubMed] 

56.  Khan S, Floris M, Pani A, Rosner MH. Sodium and Volume Disorders in Advanced Chronic Kidney Disease. Adv Chronic Kidney Dis. 2016;23(4):240-246. doi:10.1053/j.ackd.2015.12.003 [PubMed] [Elsevier]

57. Chandini Dr, Mathai DrPJ. Haematological Parameters in Patients with Alcohol Dependence Syndrome. IOSR Journal of Dental and Medical Sciences. 2017;16(05):11-16. doi:https://doi.org/10.9790/0853-1605011116 [IJCMR]

58. Raju SV, Jackson PL, Courville CA, et al. Cigarette smoke induces systemic defects in cystic fibrosis transmembrane conductance regulator function. Am J Respir Crit Care Med. 2013;188(11):1321-1330. doi:10.1164/rccm.201304-0733OC [PubMed] 

59.  Lee J, Taneja V, Vassallo R. Cigarette smoking and inflammation: cellular and molecular mechanisms. J Dent Res. 2012;91(2):142-149. doi:10.1177/0022034511421200 [PubMed]

60.  Oakes JM, Fuchs RM, Gardner JD, Lazartigues E, Yue X. Nicotine and the renin-angiotensin system. Am J Physiol Regul Integr Comp Physiol. 2018;315(5):R895-R906. doi:10.1152/ajpregu.00099.2018 [PubMed]

61. Chloride test – blood Information | Mount Sinai – New York. Mount Sinai Health System. [Mount Sinai] 

62.  Pham AQ, Xu LH, Moe OW. Drug-Induced Metabolic Acidosis. F1000Res. 2015;4:F1000 Faculty Rev-1460. Published 2015 Dec 16. doi:10.12688/f1000research.7006.1 [PubMed]

63.  Hypochloremia – an overview | ScienceDirect Topics. www.sciencedirect.com. [Elsevier] 

64.  Ray EC, Rondon-Berrios H, Boyd CR, Kleyman TR. Sodium Retention and Volume Expansion in Nephrotic Syndrome: Implications for Hypertension. Advances in Chronic Kidney Disease. 2015;22(3):179-184. doi:https://doi.org/10.1053/j.ackd.2014.11.006 [Elsevier]

65. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017;16:1057-1072. Published 2017 Jul 21. doi:10.17179/excli2017-480 [PubMed]

66.  Torres SJ, Turner AI, Nowson CA. Does stress induce salt intake? British Journal of Nutrition. 2010;103(11):1562-1568. doi:10.1017/S000711451000098X [Cambridge]

67.  Knutson KL. Impact of sleep and sleep loss on glucose homeostasis and appetite regulation. Sleep Med Clin. 2007;2(2):187-197. doi:10.1016/j.jsmc.2007.03.004 [PubMed]

68.  Hirshkowitz M, Whiton K, Albert SM, et al. National Sleep Foundation’s sleep time duration recommendations: methodology and results summary. Sleep Health. 2015;1(1):40-43. doi:10.1016/j.sleh.2014.12.010 [PubMed] [Elsevier]

69.  Hamasaki H. The Effects of Mindfulness on Glycemic Control in People with Diabetes: An Overview of Systematic Reviews and Meta-Analyses. Medicines (Basel). 2023;10(9):53. Published 2023 Sep 7. doi:10.3390/medicines10090053 [PubMed]

70.  Pascoe MC, Thompson DR, Jenkins ZM, Ski CF. Mindfulness mediates the physiological markers of stress: Systematic review and meta-analysis. J Psychiatr Res. 2017;95:156-178. doi:10.1016/j.jpsychires.2017.08.004 [PubMed] [Elsevier]