| Bromism | |
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| Specialty | Emergency medicine,psychiatry,neurology  |
Bromism is the syndrome which results from the long-term consumption ofbromine, usually through bromine-based sedatives such aspotassium bromide andlithium bromide. Bromide was used in medicinal drugs for indications as broad as insomnia, hysteria, anxiety, and even excessive libido, making it one of the most frequently used class of medicinal drugs prior to its reduction in the early 20th century.[1][2]
Bromism was once a very common disorder, being responsible for 5 to 10% of psychiatric hospital admissions, but is now uncommon since bromide was withdrawn from clinical use in many countries and was severely restricted in others.[1]
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Neurological and psychiatric symptoms are widely variable. Common symptoms may includerestlessness,irritability,ataxia,paranoia,confusion, both auditory and visualhallucinations,psychosis,weakness,stupor, and, in severe cases,coma.[3][4]
Gastrointestinal effects include nausea and vomiting as acute adverse effects. Chronic exposure may lead toanorexia orconstipation.[3]
Dermatological effects includecherry angiomas,acneiform, andpustular anderythematous rashes.[3]
High levels of bromide chronically impair the membrane of neurons, which progressively impairs neuronal transmission, leading to toxicity, known as bromism. Bromide has anelimination half-life of 9 to 12 days, which can lead to excessive accumulation. Doses of 0.5 to 1 gram per day of bromide can lead to bromism. Historically, the therapeutic dose of bromide is about 3 to 5 grams of bromide, thus explaining why chronic toxicity (bromism) was once so common. While significant and sometimes serious disturbances occur to neurologic, psychiatric, dermatological, and gastrointestinal functions, death is rare from bromism.[3] A man was poisoned in 2025, after a suggestion ofChatGPT to replacesodium chloride in his diet with sodium bromide; sodium bromide is a safe replacement only for non-nutritional purposes, i.e., cleaning.[5][6][7]
Bromism is caused by a neurotoxic effect on the brain which results insomnolence,psychosis,seizures, anddelirium.[8] Bromism has also been caused by excessive consumption ofsoft drinks that containsbrominated vegetable oil, leading toheadache,fatigue,ataxia,memory loss, and potentially inability to walk was observed in one case.[9]
Bromism is diagnosed by checking the serum chloride level, electrolytes, glucose,blood urea nitrogen andcreatinine, as well as symptoms such aspsychosis. Bromine is alsoradiopaque, so anabdominal X-ray may also help in the diagnosis.[3]
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There are no specific antidotes or protocols for bromide poisoning of the body. Increased intake of regular salt and water, which increases the flow of the related chloride ion through the body, is one way of flushing out the bromide.Furosemide may help aid urinary excretion in individuals with renal impairment or where bromide toxicity is severe.[3] In one case,hemodialysis was used to reduce bromide's half-life to 1.38 h, dramatically improving the patient's condition.[9]
Iodine deficiency is also linked to weaker (less detectable) forms of bromism.[citation needed] Iodine and bromine are closely related to each other in behavior (and location on the periodic table), and high levels of bromine displace iodine in tissues and blood when there is an opportunity to do so. Supplementary intake of iodine should be preceded by a salt loading protocol or consumption ofdietary sulfur beforehand.[citation needed]
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