Typically, IV calcium is reserved for patients with severe hypocalcemia. It is also important to check magnesium levels in patients with hypocalcemia and to replace magnesium if it is low. Chloride Chloride, after sodium, is the second most abundant electrolyte in the blood, and most abundant in the extracellular fluid. Most of the chloride in the body is from salt (NaCl) in the diet. Chloride is part of gastric acid (HCl), which plays a role in absorption of electrolytes, activating enzymes, and killing bacteria. The levels of chloride in the blood can help determine if there are underlying metabolic disorders. Generally, chloride has an inverse relationship with bicarbonate, an electrolyte that indicates acid-base status. Overall, treatment of chloride imbalances involve addressing the underlying cause rather than supplementing or avoiding chloride. Hyperchloremia Causes Hyperchloremia, or high chloride levels, is usually associated with excess chloride intake (e.g., saltwater drowning), fluid loss (e.g., diarrhea, sweating), and metabolic acidosis. Symptoms Patients are usually asymptomatic with mild hyperchloremia. Symptoms associated with hyperchloremia are usually caused by the underlying cause of this electrolyte imbalance. Treatment Treat the underlying cause, which commonly includes increasing fluid intake. Hypochloremia Causes Hypochloremia, or low chloride levels, are commonly associated with gastrointestinal (e.g., vomiting) and kidney (e.g., diuretics) losses. Greater water or sodium intake relative to chloride also can contribute to hypochloremia. Symptoms Patients are usually asymptomatic with mild hypochloremia. Symptoms associated with hypochloremia are usually caused by the underlying cause of this electrolyte imbalance. Treatment Treat the underlying cause, which commonly includes increasing fluid intake. Magnesium Magnesium is mostly found in the bones and within cells. Approximately 1% of total magnesium in the body is found in the blood. Magnesium is important in control of metabolism and is involved in numerous enzyme reactions. A normal range is 0.70 - 1.10 mmol/L. The kidney is responsible for maintaining the magnesium levels in this narrow range. Hypermagnesemia Hypermagnesemia, or abnormally high levels of magnesium in the blood, is relatively rare in individuals with normal kidney function. This is defined by a magnesium concentration >2.5 mg/dL. Causes Hypermagnesemia typically occurs in individuals with abnormal kidney function. This imbalance can also occur with use of antacids or laxatives that contain magnesium. Most cases of hypermagnesemia can be prevented by avoiding magnesium-containing medications. Symptoms Mild symptoms include nausea, flushing, tiredness. Neurologic symptoms are seen most commonly including decreased deep tendon reflexes. Severe symptoms include paralysis,