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Bromide intoxication by the combination of bromide-containing OTC drug and dextromethorphan hydrobro

Bromide intoxication by the combination of bromide-containing OTC drug and dextromethorphan hydrobro

  1. Heretic.Ape.
    Human and Experimental Toxicology 2003 Aug;22(8):459-61

    Hung YM

    A 30-year old woman was presented to the emergency room with marked lethargy and fever. Her physical examination showed an acneiform eruption on the face. Blood biochemistry showed a high chloride level and a negative anion gap. High blood bromide level measurements on an ion-selective electrode was noted later to cause spurious hyperchloremia with a negative anion gap. After receiving saline hydration and diuretic treatment, her serum chloride returned to normal range on hospital day nine. Slow resolution of her mental status occurred over 2 months. Her skin lesions disappeared about 5 months later. In conclusion, in face of an unusual high chloride level and a negative anion gap in a patient of long-term use of over-the-counter (OTC) agents, bromide intoxication should be included in the differential diagnosis.