MARK L. GRABER, M.D.; RICHARD J. QUIGG, M.D.; WILLIAM E. STEMPSEY, M.D.; STEPHEN WEIS, D.O.
A patient with overt lipemia presented with hyponatremia, hyperchloremia, and a negative anion gap. The hyperchloremia and negative gap resulted from overestimation of chloride levels due to a light-scattering effect in the colorimetric assay, an effect that was reproducible in vitro. In a prospective study, this effect produced substantial overestimations at even modest degrees of hyperlipemia. This effect expands the differential diagnosis of a decreased gap, adds to the list of technique-dependent artifacts in lipemia, and, if present, must be recognized for a patient's fluid and electrolyte status to be accurately defined.
MARK L. GRABER, RICHARD J. QUIGG, WILLIAM E. STEMPSEY, STEPHEN WEIS. Spurious Hyperchloremia and Decreased Anion Gap in Hyperlipidemia. Ann Intern Med. 1983;98:607–609. doi: 10.7326/0003-4819-98-5-607
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Published: Ann Intern Med. 1983;98(5_Part_1):607-609.
Cardiology, Coronary Risk Factors, Dyslipidemia, Endocrine and Metabolism, Fluid and Electrolyte Disorders.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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