Elevated serum levels of bromine do not always indicate pseudohyperchloremia
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- Ito, T., Ishikawa, E., Matsuda, Y. et al. Clin Exp Nephrol (2010) 14: 431. doi:10.1007/s10157-010-0303-2
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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.