Munekawa Chihiro, Kawasaki Tatsuya, Miyoshi Tomoki, Yamane Yusuke, Okada Hiroshi, Oyamada Hirokazu
Department of General Internal Medicine, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
Department of Cardiology, Matsushita Memorial Hospital, Moriguchi, Osaka, Japan.
Am J Case Rep. 2020 Apr 8;21:e922019. doi: 10.12659/AJCR.922019.
BACKGROUND Electrolyte imbalance is frequent in many situations, but severe hyperchloremia is markedly rare in the absence of renal impairment. We report a patient with preserved renal function who exhibited severe hyperchloremia and negative anion gap. CASE REPORT A 70-year-old female with preserved renal function presented with fatigue and impaired consciousness. Venous blood gas analysis was notable for a chloride level of 137 mEq/L and anion gap of -18.2 mEq/L. Careful history taking revealed that she had taken bromide-containing over-the-counter painkillers. Her symptoms and laboratory tests gradually improved after intravenous hydration and painkiller withdrawal. The serum level of bromide ions on admission was later found to be 4-times higher than that considered toxic. CONCLUSIONS It is important to recognize that hyperchloremia with a negative anion gap strongly suggests bromide intoxication, and that bromide intoxication can develop even in patients with preserved renal function. Careful history taking is essential to the diagnosis because some over-the-counter drugs that are widely available and a few prescription drugs contain bromides.
电解质失衡在许多情况下很常见，但在没有肾功能损害的情况下，严重高氯血症明显罕见。我们报告一例肾功能正常但出现严重高氯血症和阴离子间隙为负的患者。病例报告：一名70岁肾功能正常的女性出现疲劳和意识障碍。静脉血气分析显示氯水平为137 mEq/L，阴离子间隙为 -18.2 mEq/L。详细的病史询问发现她服用了含溴的非处方止痛药。静脉补液和停用止痛药后，她的症状和实验室检查逐渐改善。后来发现入院时她的血清溴离子水平比中毒水平高4倍。结论：认识到阴离子间隙为负的高氯血症强烈提示溴中毒很重要，而且即使肾功能正常的患者也可能发生溴中毒。仔细询问病史对诊断至关重要，因为一些广泛使用的非处方药和少数处方药含有溴化物。
