Hyperchloremia is an electrolyte disturbance in which there is an elevated level of chloride ions in the blood. The normal serum range for chloride is 96 to 106 mEq/L, therefore chloride levels at or above 110 mEq/L usually indicate kidney dysfunction as it is a regulator of chloride concentration. As of now there are no specific symptoms of hyperchloremia; however, it can be influenced by multiple abnormalities that cause a loss of electrolyte-free fluid,  loss of hypotonic fluid, or increased administration of sodium chloride. These abnormalities are caused by diarrhea, vomiting, increased sodium chloride intake, renal dysfunction, diuretic use, and diabetes. Hyperchloremia should not be mistaken for hyperchloremic metabolic acidosis as hyperchloremic metabolic acidosis is characterized by two major changes: a decrease in blood pH and bicarbonate levels, as well as an increase in blood chloride levels. Instead those with hyperchloremic metabolic acidosis are usually predisposed to hyperchloremia. Hyperchloremia prevalence in hospital settings has been researched in the medical field since one of the major sources of treatment at hospitals is administering saline solution. Previously, animal models with elevated chloride have displayed more inflammation markers, changes in blood pressure, increased renal vasoconstriction, and less renal blood flow as well at glomerulus filtration, all of which are prompting researchers to investigate if these changes or others may exist in patients. Some studies have reported a possible relationship between increased chloride levels and death or acute kidney injury in severely ill patients that may frequent the hospital or have prolonged visits.
Palmar erythema is reddening of the palms at the thenar and hypothenar eminences. : 139

Causes
It is associated with various physiological as well as pathological changes, or may be a normal finding:

Portal hypertension
Chronic liver disease (including chronic hepatitis)
Pregnancy
Polycythemia
Thyrotoxicosis
Rheumatoid arthritis (especially in patients with polycythaemia)
Eczema and psoriasis
Deep telangiectasias
Coxsackievirus A infection (Hand, foot and mouth disease)
Rocky Mountain spotted fever
Secondary syphilis
Kawasaki disease
Adverse drug reaction: palmoplantar erythrodysesthesia (acral erythema)Because circulating levels of estrogen increase in both cirrhosis and pregnancy, estrogen was thought to be the main cause for the increased vascularity. More recently, nitric oxide has also been implicated in the pathogenesis of palmar erythema. Diagnosis
Palmar erythema has no specific treatment. Management is based on the  underlying cause. When its cause is treated then patients get relief. If it is attributable to a particular drug then the drug should be withdrawn. See also
Toxic erythema
List of cutaneous conditions

References


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