Two cases of chronic bromvalerylurea intoxication diagnosed from pseudo-hyperclemia

Abstract

Currently, many facilities use the ion selective electrode (ISE) method for measuring electrolytes in serum and urine, and the ISE method for measuring sodium (Na) and potassium (K) uses a crown ether membrane. It is an electrode, has high specificity, and is less affected by interfering substances. ISE for measuring chloride (Cl) is a quaternary ammonium salt electrode or a silver-silver chloride electrode, which has lower specificity than a crown ether electrode and may give falsely high values if other halogen substances coexist. There are several reports in the past. We experienced two cases in which the serum Cl level was falsely high and was diagnosed as chronic bromine poisoning due to long-term use of commercially available analgesics. It is likely that there are other patients who exhibit pseudo-hyperchloremia due to over-the-counter analgesics as in these two cases, and clinical laboratory technicians and medical practitioners in charge of clinical tests must be careful. When measuring Cl, if the Cl value is high in the balance between the Na value and the Cl value, if an error occurs from the analyzer, or if you suspect that the Cl value is incorrect due to an interfering substance, contact the clinic. Is required. Checking the oral medications and looking at the relationship with clinical symptoms will lead to the discovery of bromine poisoning.