title: Bromism from excessive cola consumption.
abstract: BACKGROUND
  Bromism is an unusual occurrence. Historically bromism has been known to occur with chronic ingestion of bromide salts used as sleep medications. In this case, excessive consumption of a cola with brominated vegetable oil caused a severe case of bromism.
  
  
  METHODS
  The patient presented with headache, fatigue, ataxia, and memory loss which progressed over 30 days. He consumed 2 to 4 L of cola containing brominated vegetable oil on a daily basis before presenting with these symptoms. His significantly elevated serum chloride, as measured by ion specific methods, and negative anion gaps were overlooked during a prior hospitalization and emergency department visits. A focal neurologic finding of right eyelid ptosis led to an extensive evaluation for a central nervous system lesion. The patient continued to deteriorate, until he was no longer able to walk. A diagnosis of severe bromism was eventually made and his serum bromide was confirmed at 3180 mg/L (39.8 mmol/L). Despite saline loading the patient failed to improve but subsequent hemodialysis dramatically cleared his clinical condition, and reduced his serum bromide levels. The unilateral eyelid ptosis, a rarely reported finding in bromism, also resolved with hemodialysis.
  
  
  CONCLUSIONS
  A negative anion gap or an elevated serum chloride should prompt an evaluation for bromism. In this case hemodialysis dramatically improved the patient's clinical condition and reduced the half-life of bromide to 1.38 h.
authors.affiliation: Division of Emergency Medicine and Clinical Toxicology, University of California, Davis Medical Center, Sacramento 95817, USA.
authors.forename: B Z
authors.initials: BZ
authors.lastname: Horowitz
mesh_terms: D000136:Acid-Base Equilibrium; D000328:Adult; D001259:Ataxia / Q000139:chemically induced; D001288:Attention / Q000187:drug effects; D001628:Beverages / Q000009:adverse effects*; D001965:Bromides / Q000009:adverse effects* / Q000493:pharmacokinetics; D002712:Chlorides / Q000097:blood; D062787:Drug Overdose; D005221:Fatigue / Q000139:chemically induced; D006207:Half-Life; D006261:Headache / Q000139:chemically induced; D006801:Humans; D008279:Magnetic Resonance Imaging; D010938:Plant Oils / Q000009:adverse effects / Q000737:chemistry; D006435:Renal Dialysis; D014055:Tomography, Emission-Computed
chemical_list: D001965:Bromides; D002712:Chlorides; D010938:Plant Oils