Bromism caused by mix-formulated analgesic injectables.
Bromism, chronic bromide intoxication, can be caused by a variety of medicines, but bromism due to pain-relieving injectable medications has not been reported. In this study, the methods used were internet searching on bromide-containing injectables available in Taiwan and the first case report of bromism due to mixed-formulated injectable medication. Many analgesic/antipyretic and antihistamine injections containing bromides are still being used in Taiwan. They contain sodium bromide up to 1000 mg/ampoule or calcium bromide up to 800 mg/amp. A 25-year-old female suffered from forgetfulness and unstable gait after long-term frequent injections of a preparation to relieve head and neck pain. Blood tests showed hyperchloremia (171 mEq/L) and a negative anion gap (-48.7 mEq/L). Serum bromide measured 2150 mg/L. She recovered completely in 3 days with saline treatment. Many bromide-containing injections are still being used in Taiwan. Clinicians should keep alert on this issue to avoid iatrogenic bromism or making misdiagnoses.
Hsieh
P F
PF
Department of Internal Medicine, Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
Tsan
Y T
YT
Hung
D Z
DZ
Hsu
C L
CL
Lee
Y C
YC
Chang
M H
MH
D000136:Acid-Base Equilibrium / Q000187:drug effects; D000328:Adult; D000700:Analgesics / Q000008:administration & dosage / Q000506:poisoning*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000506:poisoning*; D017605:Bromine Compounds / Q000008:administration & dosage / Q000097:blood / Q000506:poisoning*; D002712:Chlorides / Q000097:blood; D016208:Databases, Factual; D005260:Female; D006634:Histamine H1 Antagonists / Q000008:administration & dosage / Q000506:poisoning*; D006801:Humans; D007275:Injections, Intravenous; D020407:Internet; D010468:Perceptual Disorders / Q000139:chemically induced; D011596:Psychomotor Disorders / Q000139:chemically induced; D019966:Substance-Related Disorders / Q000097:blood / Q000209:etiology*
D000700:Analgesics; D018712:Analgesics, Non-Narcotic; D017605:Bromine Compounds; D002712:Chlorides; D006634:Histamine H1 Antagonists