, Volume 14, Issue 5, pp 431-435
Date: 12 Aug 2010

Elevated serum levels of bromine do not always indicate pseudohyperchloremia

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We encountered a case of bromism that was found to be due to pseudohyperchloremia. Hyperchloremia is known to be able to reveal existing bromism, but the fact that bromine (Br) influences chloride (Cl) in assays that use ion electrode machines is not widely known.


We assayed samples by an ion electrode method, using four types of machines. Different amounts of Cl or Br were added to each sample.


With the addition of Cl to the samples, the assayed Cl concentrations were proportional to the amount of added Cl. With the addition of Br to the samples, the assayed Cl concentrations, as measured by all machines, were increased, but the amounts of the increase differed significantly, and were not proportional to the amount of Br added. In particular, in the machine most markedly influenced by additional Br, the Cl concentrations increased from 94.9 to 139.6 mEq/l with the addition of 10 mEq/l of Br. Conversely, in the least influenced machine, Cl values increased from 95.0 to 103.0 mEq/l with the addition of 10 mEq/l of Br.


The influence on the Cl assay of the addition of Br varied significantly between different ion electrode machines. Clinical nephrologists therefore need to be able to recognize the characteristics of the specific machines used in their hospitals.

Part of this paper was presented as an Award of Excellence report among case reports at the 38th West Regional Meeting of the Japanese Society of Nephrology on 26 September, 2008 (Nagoya, Japan).