Spurious Hyperchloremia and Negative Anion Gap in a Child with Refractory Epilepsy

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We report a case with spurious hyperchloremia with negative anion gap in a child who was taking potassium bromide for refractory epilepsy.

Blood chemistry showed a high chloride level (171 mEq/L) and a negative anion gap (−52 mEq/L).

Plasma chloride concentration is measured by an ion-selective electrode method; however the presence of other anions like bromide and iodides can interfere with chloride level and largely overestimates the chloride concentration.

Thus hyperchloremia with a negative anion gap is a clue to the diagnosis of halides like bromide and iodide ingestion.