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Study Design

Mao et al., 2001

Chinese soccer players, 16–18 yr

32–37°C (89.6–98.6°F)

No dietary information, 8 d


Inoue et al., 1999

9 men, 63–67 yr

90 min/d exercise, 43°C (109.4°F)

No dietary information, 8 d

Chloride Balance

Chloride losses usually accompany sodium losses. Hence conditions and diseases in which sodium is lost are likewise associated with chloride loss. Excess chloride depletion, marked by hypochloremia, results in hypochloremic metabolic alkalosis (a syndrome seen in individuals with significant vomiting), in which loss of hydrochloric acid is the primary form of chloride loss.

Much of the evidence of the effects of chloride deficiency comes from studies in the 1980s of infants who inadvertently consumed formulas that were manufactured incorrectly with low chloride content (CDC, 1979, 1980; Roy and Arant, 1979). Clinical symptoms and signs noted with the ensuing hypochloremia included growth failure, lethargy, irritability, anorexia, gastrointestinal symptoms, and weakness (Grossman et al., 1980). Some infants presented with hypokalemia, metabolic alkalosis, hematuria, hyperaldosteronism, and increased plasma renin levels (Roy, 1984). Long-term consequences to the infants of consuming the infant formulas that were inadequate in chloride have been evaluated as well (Malloy et al., 1991; Roy and Arant, 1981; Willoughby et al., 1990). Developmental screens were used to evaluate the infants (Willoughby et al., 1990), which indicated some delay in speech development. Follow-up after 9 to 10 years in the children indicated that the effects of early growth retardation had vanished and cognitive skills appeared normal, but some deficits in language skills were present in some children (Malloy et al., 1991).

Chloride deficiency is thus rarely seen given that most foods containing sodium also provide chloride, unless special medical products low in chloride are consumed.

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