Bromism

Overview

Bromism is a rare and potentially toxic condition caused by excessive intake or accumulation of bromide ions in the body. Bromide was once widely used in sedatives, anticonvulsants, and analgesics, but due to its narrow therapeutic window and risk of toxicity, it is now rarely used in modern medicine. Bromism typically results from chronic exposure, either through medications, over-the-counter products, or environmental sources. It can lead to a wide array of neurological and psychiatric symptoms, often mimicking other disorders, which makes it challenging to diagnose.

Causes

Bromism occurs when bromide ions accumulate in the body to toxic levels, disrupting normal neuronal function. Common causes include:

• Chronic use of bromide-containing medications – such as potassium bromide (used historically for epilepsy or sedation)

• Excessive intake of over-the-counter products – some older pain relievers, cough syrups, and sedatives contained bromide salts

• Occupational or environmental exposure – rare, but possible through industrial use of bromine or contamination

• Reduced renal clearance – bromide is eliminated through the kidneys, so individuals with kidney dysfunction may be more susceptible to accumulation

Symptoms

Symptoms of bromism can develop gradually and may affect multiple organ systems, particularly the central nervous system. Common signs and symptoms include:

• Neurological symptoms:

  • Lethargy and fatigue

  • Headaches

  • Confusion, hallucinations, or psychosis

  • Ataxia (loss of coordination)

  • Tremors or myoclonus (muscle jerks)

  • Slurred speech

  • Coma in severe cases

• Gastrointestinal symptoms:

  • Nausea and vomiting

  • Abdominal pain

  • Loss of appetite

• Dermatological findings:

  • Skin rashes or acneiform eruptions (bromoderma)

  • Mucous membrane irritation

• Psychiatric symptoms:

  • Depression or personality changes

  • Memory problems

Diagnosis

Diagnosis of bromism can be difficult due to its nonspecific presentation. Key steps in the diagnostic process include:

• Detailed medical history – including any use of bromide-containing products or supplements

• Serum bromide levels – levels above 50 mg/dL (or 6.25 mmol/L) are typically considered toxic

• Serum chloride pseudohyperchloremia – bromide can interfere with some chloride assays, falsely elevating chloride readings

• Neuroimaging – such as CT or MRI may be performed to rule out other causes but are often normal in bromism

• Electrolyte panel and renal function tests – to assess related abnormalities or underlying renal issues

Treatment

The primary treatment for bromism is the prompt elimination of bromide from the body and supportive care. Treatment options include:

• Discontinuation of bromide exposure – stopping the use of any bromide-containing medications or supplements

• Saline diuresis – administration of intravenous saline (sodium chloride) helps increase renal excretion of bromide through competition with chloride

• Furosemide (a diuretic) – may be used alongside saline to enhance elimination

• Hemodialysis – in severe or refractory cases, particularly with impaired renal function or extremely high bromide levels

• Supportive care – managing symptoms such as seizures, delirium, or coma in a hospital setting

Prognosis

With early recognition and treatment, the prognosis for bromism is generally excellent. Most patients recover fully once bromide is cleared from the system. However, delayed diagnosis or ongoing exposure may lead to prolonged neurological impairment or, rarely, fatal outcomes. Prevention through awareness of bromide sources and cautious use of medications is key, especially in vulnerable populations such as those with kidney disease.