Marked Hyperchloremia and Negative Anion Gap as Clues to Diagnose Bromide Intoxication

二十二歲女性因為出現精神錯亂，跳耀式意念，睡眠減少，經由本院急診收入精神科住院治療。過去病史發現病人曾因慢性頭痛於近六個月服用非處方止痛藥。入院後理學檢查並無特殊發現。實驗室檢查：血清氯離子232 mmol/L，陰離子間隙：負116 mEq/L；在排除高血脂症，多發性骨髓瘤和鋰監中毒的可能性後，高度懷疑溴化物中毒。經檢查血清溴離子25.4 mEq/L（203 mg/dl）大於正敘值範圍12.5至18.8 mEq/L，確定診斷溴化物中毒。高血清溴離子濃度會干擾以離子選擇性電極方法檢驗之血清氯離子濃度，因而產生偽高氯血症併負陰離子間隙。於是病患停用含有溴戊醛尿素成份的非處方止痛藥並接受補充鹽水和利尿劑治療；經過三週後，病人精神及神經症狀明顯改善，不再復發。

關鍵字

溴化物中毒；高氯血症；溴戊醛尿素

並列摘要

A 22-year-old young girl was sent to our emergency room owing to presentation of suicidal tendancies, decreased need for sleep, distraction and compulsive habitual requests for mediation after taking a non-prescription analgesic drug containing bromvalerylurea for chronic headaches for 6 moths. Her physical examination showed no significant neurological findings except for an irritable mood. Blood biochemistry showed a high chloride level (232 mmol/L) and a negative anion gap (-116 mEq/L). After elimination of hyperlipedemia, multiple myeloma and lithium intoxication, halide intoxication was highly suspected as a possible cause. The interference of high bromide level (203 mg/dl) with serum chloride ion measurements on an ion-selective electrode resulted in spurious hyperchloremia with negative anion gap and was crucial in making the diagnosis. So she discontinued the use of habitual prescription-free medication and received threrapy with saline hydration. After 3 weeks, her neuropsychiatric symptoms were improved without later relapse.

並列關鍵字

Bromide intoxication ； hyperchloremia ； Bromvalerylurea

國際替代計量

Marked Hyperchloremia and Negative Anion Gap as Clues to Diagnose Bromide Intoxication

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