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[Factitious hyperchloremia disclosing bromide poisoning. 4 cases]

B Bonnotte1, C Jolimoy, A Pacaud

  • 1Service de Médecine 1, Néphrologie et Endocrinologie, Chu, Dijon.

Presse Medicale (Paris, France : 1983)
|May 31, 1997
PubMed
Summary

Elevated chloride levels may indicate bromism, a condition caused by bromide exposure. Discontinuing bromide-containing supplements can restore normal chloride levels and prevent neurological issues.

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Area of Science:

  • Clinical Chemistry
  • Toxicology
  • Analytical Chemistry

Background:

  • Elevated chloride in routine blood tests can signal the presence of other halides like bromide.
  • Differentiating true hyperchloremia from halide interference is crucial for accurate diagnosis.

Observation:

  • Four patients presented with hyperchloremia and a decreased anion gap.
  • Long-term use of calcium bromogalacto-glucomate was identified as the source of bromide exposure.
  • Inductively coupled plasma mass spectrometry (ICP-MS) confirmed elevated blood bromide levels.

Findings:

  • Bromide accumulation led to pseudohyperchloremia.
  • Discontinuation of bromide-containing supplements normalized chloride levels.
  • Bromism can manifest with neurological, psychiatric, and dermatological symptoms.

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Implications:

  • Bromism is an underdiagnosed condition that can mimic other electrolyte imbalances.
  • Awareness of bromide in certain medications and supplements is essential for clinicians.
  • Patient education regarding the risks of excessive bromide intake is critical to prevent adverse effects.