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Bromism caused by mix-formulated analgesic injectables

Department of Internal Medicine, Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Neurology, National Yang-Ming University, Taipei, Taiwan, Republic of China; Graduate Institute of Biomedicine and Biomedical Technology, National Chi Nan University, Nantou Hsien, Taiwan, Republic of China

YT Tsan

Department of Emergency, Division of Toxicology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China

DZ Hung

Department of Emergency, Division of Toxicology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Division of Environmental and Occupational Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China

CL Hsu

Department of Emergency, Division of Toxicology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China

YC Lee

Department of Internal Medicine, Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Neurology, National Yang-Ming University, Taipei, Taiwan, Republic of China

MH Chang

Department of Internal Medicine, Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China; Department of Neurology, National Yang-Ming University, Taipei, Taiwan, Republic of China

Bromism, chronic bromide intoxication, can be caused by a variety of medicines, but bromism due to pain-relieving injectable medications has not been reported. In this study, the methods used were internet searching on bromide-containing injectables available in Taiwan and the first case report of bromism due to mixed-formulated injectable medication. Many analgesic/antipyretic and antihistamine injections containing bromides are still being used in Taiwan. They contain sodium bromide up to 1000 mg/ampoule or calcium bromide up to 800 mg/amp. A 25-year-old female suffered from forgetfulness and unstable gait after long-term frequent injections of a preparation to relieve head and neck pain. Blood tests showed hyperchloremia (171 mEq/L) and a negative anion gap (–48.7 mEq/L). Serum bromide measured 2150 mg/L. She recovered completely in 3 days with saline treatment. Many bromide-containing injections are still being used in Taiwan. Clinicians should keep alert on this issue to avoid iatrogenic bromism or making misdiagnoses.

Key Words: anion gap • bromide intoxication • chloride • pain-killer

Human & Experimental Toxicology, Vol. 26, No. 12, 971-973 (2007)
DOI: 10.1177/0960327107087797


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