Bromism

Bromism is the syndrome which results from the long-term use of the potassium bromide based sedatives. Bromism was once a very common disorder being responsible for 5-10% of psychiatric hospital admissions. It is now an uncommon disorder due to bromide being withdrawn from clinical use in many countries and severely restricted in others. The mechanism of bromism is due to high levels of bromide chronically impairing the membrane of neurons which progressively impairs neuronal transmission which leads to toxicity. Bromide has a very long elimination half life of 9-12 days which can lead to excessive accumulation. Doses of 0.5-1 gram per day of bromide can lead to bromism. The therapeutic dose of bromide is about 3-5 grams of bromide, thus explaining why chronic toxicity (bromism) was once so common. Whilst significant and sometimes serious disturbances of neurologic, psychiatric, gastrointestinal function as well as dermatological effects occur death is rare from bromism. Bromide is still occasionally used however, for epilepsy in some countries. Bromism is caused by a neurotoxic effect on the brain which results in somnolence, psychosis, seizures and delirium.

Diagnosis
Bromism is diagnosed by checking the serum chloride level, electrolytes, glucose, BUN and creatinine, as well as symptoms such as psychosis. Bromide is also radiopaque, so an abdominal x-ray may also help in the diagnosis.

Presentation
Neurological and psychiatric symptoms are protean and include the symptoms of restlessness, irritability, ataxia, confusion, hallucinations, psychosis, weakness, stupor and in severe cases coma.
 * Neurological and psychiatric

Gastrointestinal effects include nausea and vomiting as acute adverse effects and anorexia and constipation with chronic use.
 * Gastrointestinal

Dermatological effects include acneiform, pustular and erythematous rashes.
 * Dermatological

Treatment
There are no specific antidotes for bromide, although administering chloride and fluids can help the body to excrete bromide more quickly. Furosemide may help aid urinary excretion in individuals with renal impairment or where bromide toxicity is severe.