Chronic Hypochloremia Simulating Psychoneurosis

Under conditions of sustained heat, as in the tropics, fluctuations of the level of the blood chlorides are likely to occur. Prolonged exposure to heat associated with physical activity will lead to salt depletion and diminution of blood chlorides.1If such deficiency is not made up and restoration of blood chlorides does not take place, symptoms of salt deficiency become manifest. The symptoms of heat exhaustion due to salt deficiency are described as pronounced weakness, dizziness, stupor, pallor, profuse perspiration, diminution of urine, acceleration of pulse rate and respiration, lowering of blood pressure, and occasional cramping pains in the muscles of the abdomen and extremities (heat cramps).2The onset is usually sudden and not necessarily associated with exertion. The diagnosis of heat exhaustion due to salt deficiency hardly presents difficulties as long as such a clinical picture is kept in mind. A determination of blood chlorides would seem