hypoaldosteronism hyperaldosteronism-hypo/hyperchloremia

[tbear2162001]

Hi,
which statement is correct?

Hypoaldosteronism and Addison disease cause hypochloremia or
hypoaldosteronism and Addison disease cause hyperchloremia.

Hyperaldosteronism cause hypochloremia or
hyperaldosteronism cause hyperchloremia.

Paraphrasing USMLE 2011 page 464: ,,Low chloride concetration is secondary due to high level of aldosterone. In many articles,websites, books and presentations I have found contradictory statements.One say high aldosterone = low chloride and other say viceversa.

I know and I found two mechanisms explaining it but both are contradictory.
First.

Hyperaldosteronism makes hypochloremia because carbonates are retaining and Chlorides are excreting due electroneutrality.

Second.
Hyperaldosteronism makes hyperchloremia because natrium is pumped in more and this creates gradient, which push chlorides paracellulary in and also Cl/anion exchanger is regulated by aldosterone.

For Hypoaldosteronism obeys the same. First and second mechanism.

Source:
Critical care nephrology by Claudio Ronco and co. page 670,
Fluid and electrolytes by Mary Baumberger-Henry page 54,
Special topics in Diagnostic Testing: Blood Gases and electrolytes by John G. Toffalleti page 68

and many others

Thanks for elucidating and patient. Sorry for my english.

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[tbear2162001]

One comment.
I also found in books fact,that aldosterone stimulate NaCl resorption by increasing expression of the thiazide-sensitive sodium-chloride cotransporter in the distal convoluted tubule, the amiloride-sensitive epithelial sodium channel (ENaC) in the collecting duct, and the chloride-reabsorbing protein pendrin in the cortical collecting duct. Taken from Comprehensive Clinical nephrology (fourth edition) 2010

So there are points that suppport aldosterone cause hyperchloremia but there are also points that support theory aldosterone cause hypochloremia.