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Spurious Hyperchloremia and Decreased Anion Gap in Hyperlipidemia
- MARK L. GRABER, M.D.;
- RICHARD J. QUIGG, M.D.;
- WILLIAM E. STEMPSEY, M.D.; and
- STEPHEN WEIS, D.O.
Abstract
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.
Article and Author Information
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▸From the Division of Nephrology, Northport Veterans Administration Medical Center, Northport, New York; the Department of Medicine, SUNY at Stony Brook, Stony Brook, New York; and the Department of Laboratory Medicine, Boston University School of Medicine, Boston, Massachusetts.
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Grant support: in part by grant HRC K-092, New York State Health Research Council; and grant RR05736, National Institutes of Health.
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▸Requests for reprints should be addressed to Mark L. Graber, M.D.; Division of Nephrology, Health Sciences Center, SUNY at Stony Brook; Stony Brook, NY 11794.
