title: A negative anion gap as a clue to diagnose bromide intoxication.
abstract: We report on a patient with bromide intoxication, presenting with confusion, disorientation, and auditory and visual hallucinations after taking a sedative medication containing bromide (mixture menopause; 15 ml containing 1 g potassium bromide) for 1 month. Blood chemistry showed a high chloride level (176 mEq/l) and a negative anion gap (-60 mEq/l). The spurious hyperchloremia was due to interference of chloride ion determination by the ion-selective electrode method with a high level of bromide in serum: 352 mg/dl (44 mEq/l). In this case the only striking abnormality which alerted the physician to the possibility of halide intoxication was the negative anion gap. Hence, a negative anion gap is an important clue which leads to the diagnosis of halide intoxication.
authors.affiliation: Renal Unit, Siriaj Hospital, Mahidol University, Bangkok, Thailand.
authors.forename: S
authors.initials: S
authors.lastname: Vasuyattakul
authors.forename: N
authors.initials: N
authors.lastname: Lertpattanasuwan
authors.forename: K
authors.initials: K
authors.lastname: Vareesangthip
authors.forename: S
authors.initials: S
authors.lastname: Nimmannit
authors.forename: S
authors.initials: S
authors.lastname: Nilwarangkur
mesh_terms: D000136:Acid-Base Equilibrium / Q000187:drug effects*; D000368:Aged; D001965:Bromides / Q000097:blood / Q000506:poisoning*; D004573:Electrolytes / Q000097:blood; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000506:poisoning*; D011041:Poisoning / Q000097:blood / Q000175:diagnosis; D017680:Potassium Compounds / Q000506:poisoning*; D013130:Spinal Stenosis / Q000188:drug therapy
chemical_list: D001965:Bromides; D004573:Electrolytes; D006993:Hypnotics and Sedatives; D017680:Potassium Compounds; C039004:potassium bromide