Dietary chloride deficiency due to new liquid nutritional products

In infants the ingestion of chloride-deficient formulas was previously reported to cause hypochloremic metabolic alkalosis and hypokalemia, which is referred to as dietary chloride deficiency syndrome. Since that time, however, dietary chloride deficiency has not been commonly recognized. The aim of the present study was to evaluate the clinical features of dietary chloride deficiency syndrome caused by the ingestion of newly marketed liquid nutritional products.

This was a retrospective chart review of 59 patients with severe motor and intellectual disability (SMID); they had been given newly marketed liquid nutritional products that were later found to be chloride deficient.

Eight-nine weeks after changing to the new liquid nutritional products, clinical symptoms and laboratory abnormalities were noted. The main clinical finding was weight loss; 22% of subjects lost >5% of their bodyweight. A small number of the subjects had a mild bowel movement disorder; diarrhea and constipation were found in six and three patients, respectively. Hyponatremia, hypokalemia, and hypochloremia occurred in 33.9%, 44.5%, and 50.8%, respectively.

Chloride-deficient liquid nutritional products can cause weight loss, hypochloremic metabolic alkalosis, and hypokalemia in persons with severe motor and intellectual disability.