Bromism from excessive cola consumption

• Published in: Clinical toxicology (Philadelphia, Pa.) Pa.), 1997, Vol.35 (3), p.315-320
• Main Author: Horowitz, B.Z
• Format: Article
• Language: English
• Subjects: Acid-Base Equilibrium; Adult; Ataxia - chemically induced; Attention - drug effects; Beverages - adverse effects; Biological and medical sciences; bromides; Bromides - adverse effects; Bromides - pharmacokinetics; brominated vegetable oils; bromine; Chlorides - blood; Drug Overdose; Fatigue - chemically induced; Food toxicology; Half-Life; Headache - chemically induced; Humans; Magnetic Resonance Imaging; Medical sciences; Plant Oils - adverse effects; Plant Oils - chemistry; Renal Dialysis; Tomography, Emission-Computed; Toxicology
• ISSN: 0731-3810; 1556-3650; 1097-9875; 1556-9519
• DOI: 10.3109/15563659709001219

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. Case Report: 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.