{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T05:11:36Z","timestamp":1787893896303,"version":"build-2784847793"},"reference-count":43,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T00:00:00Z","timestamp":1604880000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Metabolic alkalosis may develop as a consequence of urinary chloride (and sodium) wasting, excessive loss of salt in the sweat, or intestinal chloride wasting, among other causes. There is also a likely underrecognized association between poor salt intake and the mentioned electrolyte and acid\u2013base abnormality. In patients with excessive loss of salt in the sweat or poor salt intake, the maintenance of metabolic alkalosis is crucially modulated by the chloride\u2013bicarbonate exchanger pendrin located on the renal tubular membrane of type B intercalated cells. In the late 1970s, recommendations were made to decrease the salt content of foods as part of an effort to minimize the tendency towards systemic hypertension. Hence, the baby food industry decided to remove added salt from formula milk. Some weeks later, approximately 200 infants (fed exclusively with formula milks with a chloride content of only 2\u20134 mmol\/L), were admitted with failure to thrive, constipation, food refusal, muscular weakness, and delayed psychomotor development. The laboratory work-up disclosed metabolic alkalosis, hypokalemia, hypochloremia, and a reduced urinary chloride excretion. In all cases, both the clinical and the laboratory features remitted in \u22647 days when the infants were fed on formula milk with a normal chloride content. Since 1982, 13 further publications reported additional cases of dietary chloride depletion. It is therefore concluded that the dietary intake of chloride, which was previously considered a \u201cmendicant\u201d ion, plays a crucial role in acid\u2013base and salt balance.<\/jats:p>","DOI":"10.3390\/nu12113436","type":"journal-article","created":{"date-parts":[[2020,11,9]],"date-time":"2020-11-09T19:08:29Z","timestamp":1604948909000},"page":"3436","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Dietary Chloride Deficiency Syndrome: Pathophysiology, History, and Systematic Literature Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Giulia C.","family":"Signorelli","sequence":"first","affiliation":[{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"},{"name":"Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mario G.","family":"Bianchetti","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luca M. M.","family":"Jermini","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5006-0832","authenticated-orcid":false,"given":"Carlo","family":"Agostoni","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP), 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3829-4254","authenticated-orcid":false,"given":"Gregorio P.","family":"Milani","sequence":"additional","affiliation":[{"name":"Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland"},{"name":"Pediatric Unit, Fondazione IRCCS Ca\u2019 Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy"},{"name":"Department of Clinical Sciences and Community Health, Universit\u00e0 degli Studi di Milano, 20122 Milan, Italy"},{"name":"Italian Society for Pediatric Gastroenterology Hepatology and Nutrition (SIGENP), 20126 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo D.","family":"Simonetti","sequence":"additional","affiliation":[{"name":"Facolt\u00e0 di Scienze Biomediche, Universit\u00e0 della Svizzera Italiana, 6900 Lugano, Switzerland"},{"name":"Pediatric Institute of Southern Switzerland, Ospedale San Giovanni, 6500 Bellinzona, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sebastiano A. G.","family":"Lava","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Department of Pediatrics, Centre Hospitalier Universitaire Vaudois, and University of Lausanne, 1011 Lausanne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,11,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"235","DOI":"10.1016\/S0065-3101(24)00200-7","article-title":"The chloride depletion syndrome","volume":"31","author":"Roy","year":"1984","journal-title":"Adv. Pediatr."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"453","DOI":"10.1016\/j.emc.2014.01.005","article-title":"Approach to Metabolic Alkalosis","volume":"32","author":"Soifer","year":"2014","journal-title":"Emerg. Med. Clin. N. 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