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Bromide intoxication by the combination of bromide-containing over-the-counter drug and dextromethorphan hydrobromide

Department of Internal Medicine, Kaohsiung Veterans General Hospital, Taiwan

A 30-year old woman was presented to the emergency room with marked lethargy and fever. Her physical examination showed an acneiform eruption on the face. Blood biochemistry showed a high chloride level and a negative anion gap. High blood bromide level measurements on an ion-selective electrode was noted later to cause spurious hyperchloremia with a negative anion gap. After receiving saline hydration and diuretic treatment, her serum chloride returned to normal range on hospital day nine. Slow resolution of her mental status occurred over 2 months. Her skin lesions disappeared about 5 months later. In conclusion, in face of an unusual high chloride level and a negative anion gap in a patient of long-term use of over-the-counter (OTC) agents, bromide intoxication should be included in the differential diagnosis.

Key Words: Bromide intoxication • negative anion gap • over-thecounter agents • spurious hyperchloremia

Human & Experimental Toxicology, Vol. 22, No. 8, 459-461 (2003)
DOI: 10.1191/0960327103ht380cr


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