Mind the gap: Bromism secondary to internet-purchased supplements.

Bromism is an unusual syndrome characterized by a variety of nervous system impairments such as ataxia, confusion, and delusions. Contemporaneous cases are rare as therapeutic use of bromide-containing medications has declined, but bromides can still be obtained as unregulated dietary supplements. Bromism from dietary supplements is not well-described. We present a case of a 23-year-old male who was taking numerous supplements and developed bromism, characterized by ataxia, confusion, and persistent agitation. His laboratory evaluation revealed a large negative anion gap and a serum bromide level of 1200 mg/L (ref: 0-12 mg/L). He was treated with maintenance intravenous normal saline to promote excretion of the bromide ion and slowly returned to baseline over ten days. Bromism is an unusual but well-described constellation of neurologic impairments that presents insidiously and may be easily missed. The emergency physician should be aware of the dangers of bromide-containing dietary supplements and should educate patients taking these supplements of their risks. Copyright © 2022 Elsevier Inc. All rights reserved.

Citation

Nathan A Friedman, F Lee Cantrell. Mind the gap: Bromism secondary to internet-purchased supplements. The American journal of emergency medicine. 2022 Oct;60:229.e5-229.e6

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PMID: 35953389

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