Podcast #138: Bromide Toxicity – 1966

bromo-seltzer-bottleRun Time: 3 minutes

Author: Christopher Holmes M.D.

Educational Pearls:

  • In the chapter on altered mentation in a 1966 pamphlet on handling emergency medical situations, the number one suspicion of altered mental status was toxic substance ingestion.
  • The key suspects for toxic ingestion at that time were benzodiazepines and bromide toxicity. They specifically state in the pamphlet that opiods are rarely a cause for altered mentation.
  • Bromide was commonly used in the 18th and 19th century as a headache remedy and sedative. Until the 1970s, bromo-seltzer was used for headaches before being withdrawn from the market. Bromide is currently used to treat epilepsy in dogs and in Germany.
  • Reportedly, bromide was given to the British soldiers of WW I and people with epilepsy during Victorian times to decrease their sexual drive. Epilepsy was believed to be caused by masturbation, during the Victorian age, and therefore decreasing sexual drive decreased seizure activity.
  • The half-life of bromide is 12.5 days, so chronic use leads to bromism. 5-7% of psych admissions were due to bromism caused by the chronic use of bromide. The maximum daily recommended dose of bromide is 0.5 to 1 gram per day to avoid toxicity. In the 1960s, typical doses were between 3-5 grams per day.
  • Symptoms include somnolence, psychosis, seizures, delirium, headache, fatigue, ataxia, memory loss, restlessness, irritability, and hallucinations.
  • The treatment is a fluid flush and salt load the patient.

Link to Podcast: http://medicalminute.madewithopinion.com/bromide-toxicity-1966/

References:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2385720/pdf/ulstermedj00100-0055.pdf

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