An infant receiving long term formula that is deficient in chloride may develop hypochloremia with metabolic alkalosis.


History: use of a milk formula with insufficient chloride for several months


Clinical findings:

(1) loss of appetite

(2) failure to thrive

(3) muscle weakness

(4) lethargy


Laboratory findings:

(1) low serum chloride concentration

(2) serum sodium concentration usually normal

(3) metabolic alkalosis (elevated bicarbonate, normal to slightly increased PaCO2)

(4) severe hypokalemia


Differential diagnosis - exclude other causes of metabolic alkalosis:

(1) chronic vomiting or diarrhea

(2) potassium wastage



(1) Repletion of potassium and chloride deficiencies.

(2) Change in formula to one with adequate chloride.


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