Unexplained Bromide Toxicity Presenting as Hyperchloremia and a Negative Anion Gap

Abstract

A high serum bromide level can cause erroneously high serum chloride levels measured through routine assays. Here, we describe a case of pseudohyperchloremia in which routine labs showed a negative anion gap and elevated chloride levels measured with ion-selective assay. The serum chloride level was found to be lower when measured with a chloridometer that employs a colorimetric method of quantification. The initial serum bromide level was elevated at 1100 mg/L that was confirmed by repeating the test that again showed an elevated level of 1600 mg/L and appeared to cause erroneous hyperchloremia when using conventional serum chloride quantification methods. Our case highlights lab errors and factitious hyperchloremia as a cause of the negative anion gap caused by bromism, even without a clear history of bromide exposure. The case also underscores the importance of chloride measurement using both colorimetric methods and ion-selective assay in the case of hyperchloremia.

Novel octacationic-resorcin[4]arenes featuring quaternary ammonium groups as multivalent biocides

“…All ResQAC R compounds were tested as nitrate salts to avoid bromide and iodide counter-anions, thereby enhancing the safety of these compounds for both humans and the environment. In fact, recent reports 29–31 indicate that iodide and bromide salts of QACs typically threaten water sources with pollution. During disinfection, they can produce harmful by-products such as brominated disinfection by-products (Br-DBPs) and iodinated disinfection by-products (I-DBPs), which pose significant health risks.…”

“…During disinfection, they can produce harmful by-products such as brominated disinfection by-products (Br-DBPs) and iodinated disinfection by-products (I-DBPs), which pose significant health risks. 29–31 All ResQAC R compounds showed antimicrobial activity against both microbial strains, but ResQAC butyl and ResQAC undecyl were more effective, presenting lower MIC and MLD values (Table 1). The toxic activity was variable with respect to the bacterial group.…”

New Materials Used for the Development of Anion-Selective Electrodes—A Review

“…This is quite dangerous because in human organisms the substitution of iodine by bromide ions can occur, for example, in thyroid cells, which can cause dysfunction of this organ and of other functioning on the basis of thyroid hormone homeostasis. In addition, bromine as a toxin causes nervous system and neuropsychiatric disorders, problems with excessive muscle tremors and induces dermatological diseases, i.e., dermatitis and rashes [63,64]. Due to its toxicity, it is necessary to determine this element, e.g., in water and food, in order to verify whether the potential product can be safely consumed by humans.…”