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Bromism and various toxicities: case report A 47-year-old woman developed tachycardia, multiple pustules and acneiform papules on her face, emotional lability, acidosis and bromism secondary to dextromethorphan/guaifenesin/phenylephrine abuse at an overdose [duration of treatment to reaction onsets not stated]. The woman, who had a history of depression and substance abuse, presented to the emergency department following ingestion of 50 pills of dextromethorphan/guaifenesin/phenylephrine [Robitussin] containing 20mg of dextromethorphan hydrobromide. Her medical history was significant for chronic dextromethorphan/guaifenesin/phenylephrine abuse, and she presented to the emergency department 4 days prior for similar presentation. Physical examination revealed that she was afebrile, had BP of 148/85mm Hg, mild tachycardia and had multiple pustules acneiform papules on her face. She was also noted to be emotionally labile. Her laboratory findings were significant for decreased bicarbonate, acidosis and consistent low and negative anion gaps. Additionally, her serum bromide level was markedly elevated. She was diagnosed with bromism secondary to chronic dextromethorphan/guaifenesin/phenylephrine abuse. The woman was treated with fluids and sodium bicarbonate in emergency department. She was admitted and was continued on fluids. Thereafter, she received an additional dose of sodium bicarbonate resulting in resolution of acidosis. She was then transferred to an inpatient psychiatric unit for 4 days and received bupropion for depression. Her medication was chosen specifically considering her risk of developing serotonin syndrome in case she ingests dextromethorphan/guaifenesin/phenylephrine again. She was discharged in a stable condition. Monks S, et al. Bromism: An overlooked and elusive toxidrome from chronic dextromethorphan abuse. American Journal of Emergency Medicine 38: No. 8, Aug 2020. 803498212 Available from: URL: http://doi.org/10.1016/j.ajem.2019.158491

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Reactions 29 Aug 2020 No. 1819