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A negative anion gap as a clue to diagnose bromide intoxication
S Vasuyattakul1, N Lertpattanasuwan, K Vareesangthip
1Renal Unit, Siriaj Hospital, Mahidol University, Bangkok, Thailand.
Nephron
|January 1, 1995
Summary
A patient developed bromide intoxication from a sedative, experiencing confusion and hallucinations. A negative anion gap in blood tests was the key indicator of this halide intoxication.
Area of Science:
- Clinical Toxicology
- Internal Medicine
- Pharmacology
Background:
- Bromide intoxication can occur from prolonged use of medications containing bromide salts.
- Sedative medications containing bromide, such as Mixture Menopause, pose a risk for toxicity.
Observation:
- A patient presented with confusion, disorientation, and hallucinations after a month of using a bromide-containing sedative.
- Blood chemistry revealed elevated chloride levels and a significantly negative anion gap.
Findings:
- The elevated chloride was a spurious result caused by bromide interference with the ion-selective electrode method.
- Serum bromide levels were high (352 mg/dl or 44 mEq/l).
- The negative anion gap was the critical diagnostic clue for halide intoxication.
Implications:
- A negative anion gap is a crucial indicator for diagnosing halide intoxication.
- Clinicians should consider bromide toxicity in patients with unexplained neurological symptoms and electrolyte abnormalities.
- Accurate electrolyte measurement is vital, especially when bromide interference is suspected.