From the Research
High bromide levels in the body are significant because they can indicate bromide toxicity, which causes symptoms ranging from mild sedation to severe neurological impairment, as seen in a case of chronic bromide toxicity from recurrent over-the-counter Robitussin HBr use 1. The significance of hyperbromidemia (elevated bromide level) lies in its potential to cause bromide toxicity, which can manifest with a range of symptoms including drowsiness, confusion, irritability, headache, slurred speech, weakness, skin rashes, and in severe cases, psychosis or coma.
Key Points to Consider
- Bromide toxicity typically occurs at serum levels above 50 mg/dL, though symptoms can appear at lower concentrations in some individuals.
- Bromide accumulates in the body because it has a long half-life (about 12 days) and competes with chloride for reabsorption in the kidneys.
- Treatment involves discontinuing the bromide source and administering sodium chloride (saline) to enhance bromide excretion, with hemodialysis being necessary in severe cases.
- Bromide exposure typically comes from medications containing bromide salts, certain industrial chemicals, or contaminated food or water.
- Regular monitoring of bromide levels is important for those taking bromide-containing medications or with occupational exposure, as proper diagnosis is crucial since bromide toxicity can mimic other neurological or psychiatric conditions. Some key studies have highlighted the importance of considering bromide toxicity in patients with unexplained neurological or psychiatric symptoms, particularly when there is a history of bromide exposure or a negative anion gap is present 2, 3, 4, 5.
Clinical Implications
- A negative anion gap or an elevated serum chloride should prompt an evaluation for bromism.
- Hemodialysis can dramatically improve the patient's clinical condition and reduce the half-life of bromide.
- The unilateral eyelid ptosis, a rarely reported finding in bromism, can also resolve with hemodialysis. Given the potential for severe neurological impairment and the importance of prompt diagnosis and treatment, it is crucial to consider bromide toxicity in the differential diagnosis of patients with unexplained neurological or psychiatric symptoms, particularly when there is a history of bromide exposure or abnormal electrolyte levels 1.