Spurious hyperchloremia and decreased anion gap in hyperlipidemia.
A patient with overt lipemia presented with hyponatremia, hyperchloremia, and a negative anion gap. The hyperchloremia and negative gap resulted from overestimation of chloride levels due to a light-scattering effect in the colorimetric assay, an effect that was reproducible in vitro. In a prospective study, this effect produced substantial overestimations at even modest degrees of hyperlipemia. This effect expands the differential diagnosis of a decreased gap, adds to the list of technique-dependent artifacts in lipemia, and, if present, must be recognized for a patient's fluid and electrolyte status to be accurately defined.
D000328:Adult; D001322:Autoanalysis / Q000295:instrumentation; D002712:Chlorides / Q000097:blood; D003937:Diagnosis, Differential; D004573:Electrolytes / Q000097:blood*; D005189:False Positive Reactions; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood*; D007010:Hyponatremia / Q000097:blood; D008297:Male; D011446:Prospective Studies
D002712:Chlorides; D004573:Electrolytes