The patient: A 60-year-old man in Seattle
The symptoms: The man experienced paranoia, as well as auditory and visual hallucinations. He was also very thirsty but was fearful of drinking water that others offered to him.
What happened next: The man went to an emergency department because he was worried that his neighbor poisoned him. Doctors checked his vital signs and conducted a neurological examination, which did not highlight any immediate concerns.
That changed when blood tests revealed that his level of chloride ions — charged particles of the element chlorine — were above the normal range. This result suggested that the patient may have been suffering from hyperchloremia, a condition in which chloride ions build up in the blood. This usually occurs in people who are dehydrated or consume too much salt.
However, when doctors measured the concentration of other ions in the patient's blood, they realized that this initial interpretation was wrong.
In patients with hyperchloremia, the body cancels out the increase ...
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