Spurious hyperchloremia and decreased anion gap in a patient with dextromethorphan bromide.
Although cold syrup containing dextromethorpan bromide is widely administered, the bromism due to cold syrup has not been reported. We report a patient who had negative anion gap with hyperchloremia and conscious loss because of daily intake of cold complex syrup (containing dextromethorphan bromide 0.4 mg/ml, acetaminophen 8.33 mg/ml) for headache for 4-5 years. The bromide content in cold complex syrup resulted in serum levels of bromide that interfered with the automated analyzers for chloride content. When conscious change is due to bromism, hemodialysis instead of forced hydration and diuresis should be performed immediately. Therefore, patients with a markedly negative anion gap with hyperchloremia should be considered as having halide intoxication.
Ng
Y Y
YY
Division of Nephrology, Veterans General Hospital, Taipei, Taiwan, ROC.
Lin
W L
WL
Chen
T W
TW
Lin
B C
BC
Tsai
S H
SH
Chang
C C
CC
Huang
T P
TP
D001965:Bromides / Q000008:administration & dosage / Q000506:poisoning*; D002712:Chlorides / Q000097:blood*; D003915:Dextromethorphan / Q000008:administration & dosage*; D004338:Drug Combinations; D006801:Humans; D008297:Male; D008875:Middle Aged; D004366:Nonprescription Drugs / Q000506:poisoning*; D006435:Renal Dialysis; D012646:Self Administration; D014474:Unconsciousness / Q000139:chemically induced; D014883:Water-Electrolyte Imbalance / Q000097:blood / Q000139:chemically induced* / Q000628:therapy
D001965:Bromides; D002712:Chlorides; D004338:Drug Combinations; D004366:Nonprescription Drugs; D003915:Dextromethorphan