DKA and chloride

 Q: Patients with Diabetes Ketoacidosis (DKA) may have? (select one)

A) pseudohypochloremia 

B) pseudohyperchloremia

Answer: B

Significant hyperlipidemia is common in DKA. This makes serum lactescent. Hyperlipidemia displaces water in plasma. Once plasma water phase fraction is below 93%, it can give an erroneous reading on electrolytes particularly sodium and chloride. Pseudohyponatremia is a well-known feature of DKA. In contrast, it may cause pseudohyperchloremia. 

Said that these effects are not universal and largely depend on the method used by the lab to test electrolytes. It would be prudent to discuss with labs prior to making any adjustment calculations. 

Salicylate and bromide poisonings are other well-known causes of pseudohyperchloremia.

#electrolytes

#endocrine

References:

1. Kaminska ES, Pourmotabbed G. Spurious laboratory values in diabetic ketoacidosis and hyperlipidemia. Am J Emerg Med 1993; 11:77. 

2. Graber ML, Quigg RJ, Stempsey WE, Weis S. Spurious hyperchloremia and decreased anion gap in hyperlipidemia. Ann Intern Med 1983; 98:607. 

3. Wiederkehr MR, Benevides R Jr, Santa Ana CA, Emmett M. Pseudohyperchloremia and Negative Anion Gap - Think Salicylate! Am J Med. 2021 Sep;134(9):1170-1174. doi: 10.1016/j.amjmed.2021.03.017. Epub 2021 Apr 20. PMID: 33864761. 

4. Danel VC, Saviuc PF, Hardy GA, Lafond JL, Mallaret MP. Bromide intoxication and pseudohyperchloremia. Ann Pharmacother. 2001 Mar;35(3):386-7. doi: 10.1345/aph.10156. PMID: 11261542.