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J Toxicol Clin Toxicol. 1997;35(3):315-20.

Bromism from excessive cola consumption.

Author information

  • Division of Emergency Medicine and Clinical Toxicology, University of California, Davis Medical Center, Sacramento 95817, USA.

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.

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.

PMID:
9140329
[PubMed - indexed for MEDLINE]
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