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.
GRABER ML, QUIGG RJ, STEMPSEY WE, et al. 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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