Clinical and forensic aspects of bromism: manifestations and treatment

Abstract

Background: Bromism results from bromide intoxication. Normally bromism is hard to diagnose because it mimics a myriad of psychiatric disturbs. Drug exposure or contaminated drinks are the most common causes and in most extensive forms it may result in coma or death. Objective: This work aims to fully review the state-of-the-art of bromism regarding its pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features. Methods: An exhaustive search was made in PubMed for the terms bromism, bromide and bromoderma. Results: Bromism may occur in any age or gender but is more frequent in woman probably due to more drugs administration. When in children, usually under therapy to resistant epilepsy or breastfeed by mothers who ingested bromide, bromism may manifest as bromoderma. In adults bromism manifest with psychiatrically and neurological signs as hallucinations, delusional or ataxia. The diagnosis is suspected by an hyperchloremia with a negative anion gap. The treatment requires the removal of bromide which is achieved by per os or intravenous saline administration. Gastric aspiration may be helpful or even hemodialysis. Clinical history is essential to identify any sources, allowing us to achieve a correct diagnosis and treatment. Conclusion: Bromism is not usually seen in clinical and forensic practice. It is related to the abuse of controlled or immediate-release formulations, nowadays mainly analgesics or antiepileptic drugs, that could be in tablets or liquid form. Its consequences depend not only on the doses but the duration of the exposure and the individual susceptibility.