Hennepin Healthcare - Department of Emergency Medicine, 701 South 8th Street, Minneapolis, MN, 55415, USA.
Minnesota Poison Control System, Minneapolis, MN, USA.
J Med Toxicol. 2019 Jul;15(3):192-197. doi: 10.1007/s13181-019-00706-1. Epub 2019 Mar 22.
Dextromethorphan hydrobromide is widely available as an over-the-counter cough suppressant. A semi-synthetic opioid displaying N-methyl-D-aspartate receptor antagonism, it is commonly abused for recreational purposes. Spuriously elevated serum chloride concentrations are a well-described phenomenon in the setting of dextromethorphan hydrobromide toxicity, but evidence to suggest the development of tolerance is limited to case reports.
A 32-year-old male known to chronically ingest dextromethorphan hydrobromide for recreational purposes presented to regional hospitals on 179 occasions over 110 months and was treated for dextromethorphan toxicity on 163/174 (93.7%) of these visits. He reported a subjective need to increase his dosing over time to achieve the same degree of intoxication. Measured serum chloride over this period (n = 217) ranged from 98 to 138 mEq/L (median 115 mEq/L, IQR 110-123 mEq/L). Measured concentrations over the 110-month period progressively rose, with a fitted plot of 111.15 + 0.00232x describing the rise in measured chloride. Though not formally assessed, anion gaps tended to become progressively more negative over the observed period.
We report a patient with persistent dextromethorphan hydrobromide abuse at escalating doses whose mean serum chloride concentration increased, on average, by 0.00232 mEq/L every day over a 110-month period. This case demonstrates progressive spurious hyperchloremia secondary to bromide interference in hospital-based chloride assays, supporting the patient's reported need to dose escalate to the same desired effect. Although this artefactual laboratory finding is a well-documented result of bromide ingestion, it may be useful in identifying patterns of dextromethorphan hydrobromide use that suggest tolerance.
右美沙芬氢溴酸盐作为一种非处方止咳药广泛应用。它是一种半合成阿片类药物，具有 N-甲基-D-天冬氨酸受体拮抗作用，常被滥用于娱乐目的。在右美沙芬氢溴酸盐毒性的情况下，血清氯浓度假性升高是一种众所周知的现象，但表明出现耐受的证据仅限于病例报告。
一名 32 岁男性，已知长期为娱乐目的摄入右美沙芬氢溴酸盐，在 110 个月内 179 次就诊于地区医院，其中 163/174 次（93.7%）就诊是因为右美沙芬毒性。他报告说，随着时间的推移，他需要增加剂量才能达到相同的陶醉程度。在此期间测量的血清氯（n=217）范围为 98-138 mEq/L（中位数 115 mEq/L，IQR 110-123 mEq/L）。110 个月期间测量的浓度逐渐升高，拟合的 111.15+0.00232x 描述了测量氯的升高。虽然没有正式评估，但阴离子间隙在观察期间趋于变得越来越负。
我们报告了一名持续滥用右美沙芬氢溴酸盐的患者，其剂量逐渐增加，平均每天血清氯浓度升高 0.00232 mEq/L，持续了 110 个月。该病例表明，由于溴化物干扰基于医院的氯测定，导致假性高氯血症逐渐加重，支持患者报告的需要增加剂量以达到相同的预期效果。虽然这种人为的实验室发现是溴化物摄入的一个很好的记录结果，但它可能有助于识别表明耐受的右美沙芬氢溴酸盐使用模式。
