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Bromism: case report A 70-year-old man developed bromism during supplementation therapy with buprofen/bromisoval/ethenzamide/caffeine [route and induction not stated]. The man presented with two weeks history of abdominal discomfort, anorexia and constipation. He also reported with abdominal cramping and radiating bilaterally to the flanks with nausea, constipation, general malaise and headache. His family also reported that his consciousness was significantly altered with confusion and word-finding difficulties. His medical history included chronic kidney disease secondary to ischemic nephropathy, dyslipidemia and migraine attacks. He had been receiving ibuprofen/ bromisoval/ethenzamide/caffeine [Japanese supplement] one tablet daily for a minimum of ten years along with other drugs. Physical examination showed elevated body temperature, heart rate of 118 beats/minutes, blood pressure of 161/88mm Hg and Glasgow coma scale score of with disorientation and agitation. Neurological examination showed confusion, agitation and an inability to follow commands. Bilateral clonus of 4 to 5 beats in the lower extremities with a right upper extremity action tremor and spreading of the patellar reflexes to the contralateral leg was also noted. His lab tests showed negative anion gap and elevated chloride level [duration of treatment to reaction onset not stated]. The man was treated with sodium chloride along with supportive medical care. Subsequently, his clinical and biochemical parameters improved. He was discharged with complete resolution of his confusion and neurologic abnormalities. At discharge, his lab tests showed normal chloride level with normal anion gap. His hyperchloremia was determined to be pseudohyperchloremia due to a laboratory testing abnormality from the elevated levels of bromide in his blood. His plasma bromide level drawn on admission returned several weeks later and was found to be > 100 mg/dL. He was finally diagnosed with bromism. He was advised to discontinue ibuprofen/bromisoval/ethenzamide/caffeine, and he had no recurrence of clinical symptoms. Thornton CS, et al. Bromism in the Modern Day: Case Report and Canadian Review of Bromide Intoxication. Journal of General Internal Medicine 35: 2459-2461, No. 8, 803501055 Aug 2020. Available from: URL: http://doi.org/10.1007/s11606-020-05907-x

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Reactions 12 Sep 2020 No. 1821