Bromism is the syndrome which results from the long-term use of the potassium bromide

Potassium bromide

Potassium bromide is a salt, widely used as an anticonvulsant and a sedative in the late 19th and early 20th centuries, with over-the-counter use extending to 1975 in the United States. Its action is due to the bromide ion...

 based sedatives. Bromism was once a very common disorder being responsible for 5-10% of psychiatric hospital admissions. It is now an uncommon disorder due to bromide being withdrawn from clinical use in many countries and severely restricted in others. The mechanism of bromism is due to high levels of bromide chronically impairing the membrane of neurons which progressively impairs neuronal transmission which leads to toxicity. Bromide has a very long elimination half-life of 9–12 days which can lead to excessive accumulation. Doses of 0.5-1 gram per day of bromide can lead to bromism. The therapeutic dose of bromide is about 3-5 grams of bromide, thus explaining why chronic toxicity (bromism) was once so common. While significant and sometimes serious disturbances occur to neurologic, psychiatric, dermatological, and gastrointestinal functions, death is rare from bromism. Bromide is still occasionally used however, for epilepsy in some countries. Bromism is caused by a neurotoxic effect on the brain which results in somnolence

Somnolence

Somnolence is a state of near-sleep, a strong desire for sleep, or sleeping for unusually long periods . It has two distinct meanings, referring both to the usual state preceding falling asleep, and the chronic condition referring to being in that state independent of a circadian rhythm...

, psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

, seizures and delirium

Delirium

Delirium or acute confusional state is a common and severe neuropsychiatric syndrome with core features of acute onset and fluctuating course, attentional deficits and generalized severe disorganization of behavior...

.

Diagnosis

Bromism is diagnosed by checking the serum chloride level, electrolytes, glucose, BUN

Blood urea nitrogen

The blood urea nitrogen test is a measure of the amount of nitrogen in the blood in the form of urea, and a measurement of renal function. Urea is a by- product from metabolism of proteins by the liver and is removed from the blood by the kidneys.-Physiology:The liver produces urea in the urea...

 and creatinine, as well as symptoms such as psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

. Bromide is also radiopaque

Radiodensity

Radiodensity refers to the relative inability of electromagnetic radiation, particularly X-rays, to pass through a particular material. Radiolucency indicates greater transparency or "transradiancy" to X-ray photons...

, so an abdominal x-ray

Abdominal x-ray

An abdominal x-ray is an x-ray of the abdomen. It is sometimes abbreviated to AXR, or KUB .-Diagnostic Tool:...

 may also help in the diagnosis.

Presentation

Neurological and psychiatric
Neurological and psychiatric symptoms are protean and include the symptoms of restlessness

Anxiety

Anxiety is a psychological and physiological state characterized by somatic, emotional, cognitive, and behavioral components. The root meaning of the word anxiety is 'to vex or trouble'; in either presence or absence of psychological stress, anxiety can create feelings of fear, worry, uneasiness,...

, irritability

Irritability

Irritability is an excessive response to stimuli. The term is used for both the physiological reaction to stimuli and for the pathological, abnormal or excessive sensitivity to stimuli; It is usually used to refer to anger or frustration....

, ataxia

Ataxia

Ataxia is a neurological sign and symptom that consists of gross lack of coordination of muscle movements. Ataxia is a non-specific clinical manifestation implying dysfunction of the parts of the nervous system that coordinate movement, such as the cerebellum...

, confusion

ConFusion

ConFusion is an annual science fiction convention organized by the Stilyagi Air Corps and its parent organization, the Ann Arbor Science Fiction Association. Commonly, it is held the third weekend of January. It is the oldest science fiction convention in Michigan, a regional, general SF con...

, hallucinations, psychosis

Psychosis

Psychosis means abnormal condition of the mind, and is a generic psychiatric term for a mental state often described as involving a "loss of contact with reality"...

, weakness

Weakness

Weakness is a symptom represented, medically, by a number of different conditions, including: lack of muscle strength, malaise, dizziness, or fatigue. The causes are many and can be divided into conditions that have true or perceived muscle weakness. True muscle weakness is a primary symptom of a...

, stupor

Stupor

Stupor is the lack of critical cognitive function and level of consciousness wherein a sufferer is almost entirely unresponsive and only responds to base stimuli such as pain. This is often mistaken for delirium and treated with Haldol and or other anti-psychotic drugs...

 and in severe cases coma

Coma

In medicine, a coma is a state of unconsciousness, lasting more than 6 hours in which a person cannot be awakened, fails to respond normally to painful stimuli, light or sound, lacks a normal sleep-wake cycle and does not initiate voluntary actions. A person in a state of coma is described as...

.

Gastrointestinal
Gastrointestinal effects include nausea and vomiting as acute adverse effects and anorexia

Anorexia (symptom)

Anorexia is the decreased sensation of appetite...

 and constipation

Constipation

Constipation refers to bowel movements that are infrequent or hard to pass. Constipation is a common cause of painful defecation...

 with chronic use.

Dermatological
Dermatological effects include acneiform

Acneiform eruption

Acneiform eruption refers to a group of dermatoses including acne vulgaris, rosacea, folliculitis, and perioral dermatitis. Restated, acneiform eruptions are follicular eruptions characterized by papules and pustules resembling acne....

, pustular

Abscess

An abscess is a collection of pus that has accumulated in a cavity formed by the tissue in which the pus resides due to an infectious process or other foreign materials...

 and erythema

Erythema

Erythema is redness of the skin, caused by hyperemia of the capillaries in the lower layers of the skin. It occurs with any skin injury, infection, or inflammation...

tous rashes.

Treatment

There are no specific antidotes for bromide, although administering chloride and fluids can help the body to excrete bromide more quickly. Furosemide may help aid urinary excretion in individuals with renal impairment or where bromide toxicity is severe.