Bromism is a chronic poisoning that results from prolonged ingestion of bromides. In advanced stages, bromism causes dark spots on the skin and severe emaciation.
What is bromism?
Bromism describes chronic poisoning by bromine. In the past, it was one of the common diseases in Europe. In particular, psychiatric patients included many individuals who suffered from bromism – because bromism leads to a variety of neurological and psychological symptoms such as psychosis, somnolence, seizures, or poor concentration. Conversely, bromine was also used in the treatment of psychiatric and neurological disorders. Up to five to ten percent of psychiatric patients are said to have suffered from bromism. It was not until the 1980s that the number of sufferers decreased significantly, as drugs containing bromine compounds were prescribed less frequently. Today, physicians still value bromine for its effect as a tranquilizer (sedative) and use it, for example, to treat epileptic seizures, which can cause bromine poisoning in turn if the wrong dosage is used. The correct dosage is therefore of great importance.
Causes
Bromine affects the nervous system and causes bromism when poisoned. The symptoms result from a disruption of the membranes of the nerve cells by the bromides. Usually, the human body absorbs bromine through appropriate medications, which were widely used in the past and were mistakenly considered harmless. Even today, bromine is still used as a drug in pharmacy. However, medicines containing bromine have been subject to prescription since the late 1970s, and their use is monitored by a doctor through regular blood tests. This prevents bromism from developing because patients can reduce the dose or stop the drug before bromism develops. Infants can also develop bromism, especially if they ingest bromine through breast milk. In addition, however, bromine is now thought to be released during waste incineration or via insecticides. As a result, it could enter the organism as an environmental toxin, for example, through the skin, the respiratory tract or indirectly through contaminated food. However, it is questionable whether this would allow sufficiently high amounts to enter the human body to cause bromism. Bromides occur in higher amounts in lithium bromide, which is used in absorption refrigeration machines for cooling.
Symptoms, complaints, and signs
Bromism manifests itself in various neurological and psychological symptoms. These include seizures and somnolence, a quantitative disturbance of consciousness. This mild clouding of consciousness circumscribes a proportionate impairment of wakefulness (vigilance). Somnolence manifests as drowsiness and sleepiness beyond normal levels. Other psychiatric symptoms that may appear are increased agitation, irritability, hallucinations, tremor, insomnia, and psychotic symptoms. Other signs of bromism include weakness, drowsiness, concentration problems, and coma. Coma is distinguished from somnolence as the most severe quantitative disturbance of consciousness in that affected individuals are neither responsive nor wakeable. If stupor occurs in the context of bromism, the affected person suffers from paralysis of the whole body, while being unclouded conscious. Ataxia, a disturbance in the coordination of movements, may also indicate bromism. In addition, gastrointestinal symptoms such as loss of appetite and vomiting may occur with bromism.
Diagnosis and course
An examination of the affected person’s blood or urine will allow the diagnosis to be made, as it will provide information about the amount of bromine in the body. In addition, an x-ray examination of the abdomen may provide clarity: Since bromides do not transmit X-rays, this is a clear sign of bromides in the body of the affected person. In addition, bromism is usually accompanied by disturbances in blood levels of glucose, creatine, and electrolytes, which can provide an initial clue even without specific testing for bromides. Without treatment, symptoms of bromism intensify and overall health deteriorates. In the advanced course of bromism, the highly visible bromacne may appear. These are small abscesses that leave pigmented scars as they heal.Bromacne may develop into bromoderma in some cases without treatment. Blistering characterizes the form Bromoderma bullosum. If the bromoderma manifests itself as ulcerated granulation of brown to black-red color, medicine speaks of bromoderma tuberosum. This form of bromoderma also heals with pigmented scar. Pictorial representations of bromoderma therefore often show individuals with dark skin patches. Bromism can also lead to physical emaciation (cachexia) due to prolonged poisoning.
Complications
Bromism can lead to several complications. First, bromide poisoning affects the membranes of neurons, increasing the risk for psychosis and somnolence. Depending on the severity of the bromism, irritation, drowsiness, and hallucinations may subsequently occur, as well as lassitude and paralysis. In extreme cases, bromide poisoning leads to coma or death of the affected person. In addition to these disturbances of consciousness, bromism can lead to seizures and gastrointestinal symptoms such as loss of appetite and vomiting. A chronic course is often associated with the development of abscesses and erythema. Rarely, skin manifestations such as “bromic acne” occur, which is associated with painful pustules, itching, and typical fever symptoms. Other possible complications of bromism include: Pain on breathing, ataxia, and stupor. If movement disorders and symptoms of paralysis are present, additional complications may occur later in the course of the disease. Since bromism occurs predominantly in infants and young children, there is a risk that permanent developmental disorders may develop from the symptoms. In a chronic course, it can also lead to the formation of scars and chronic infections. If bromism is detected early, however, serious complications can usually be avoided.
When should you see a doctor?
Some symptoms of bromism are so severe that, in most cases, affected individuals or those around them will notify a physician without suspecting that bromism is involved. This is the case, for example, with the onset of stupor, coma, or bromic acne. In addition, seizures, persistent nausea, or psychosis also prompt affected individuals or those around them to act. Since bromism has become rare and is almost unknown among younger people, a precise clarification of the symptoms – which can occur similarly in other poisonings – is important. For this purpose, the affected person should be hospitalized. Persons suffering from increased nausea, cramps, skin irritations, hallucinations or other symptoms of bromism should consult a physician, who can draw initial conclusions by means of a medical history. In rare cases, medications or high bromine exposure can still trigger bromism. Also, bromine-containing salts are again increasingly used as anticonvulsants (to treat seizures). Children with symptoms of bromism should be urgently examined by a physician, as they are more sensitive to the poisoning. In addition, if breastfed babies are involved, the mother should be examined, as the milk may be contaminated.
Treatment and therapy
No specific treatment exists for bromism. Reducing the ingested dose or discontinuing bromine-containing medications are essential. Although no specific antidote exists, chloride and fluoride should tend to promote bromide excretion. Furthermore, treatment with furosemide may be considered for bromism. This is a loop diuretic that promotes fluid excretion. This may allow the body to excrete the bromine more quickly. Several companies manufacture furosemide and market it under their respective trade names. Because it is a potent loop diuretic, some of which can result in severe side effects, it should be taken only on medical advice.
Outlook and prognosis
Bromism allows for very different prognoses. Children, for example, suffer more from the late effects than adults, because developmental problems (usually due to infections that develop as a result of skin damage and damage to the central nervous system) may still occur in children. None of the symptoms that occur with bromism are fatal in themselves. However, it is the many skin lesions and the weakening of the gastrointestinal tract that cause the body to become emaciated. Thus, prolonged digestive distress and nausea are not uncommon.The resulting nutrient deficiency, in combination with the constant extra strain on the body caused by the other symptoms of poisoning, then leads to a weakening of the whole person. While the skin changes and the limitations of the digestive system can be easily remedied by draining the bromine (the scars usually remain), the damage to the nerves is usually irreparable. While a stupor subsequently means that the affected person is a nursing case, other effects – especially those of a psychological nature – do not necessarily affect life expectancy. If bromine continues to enter the body, bromism will be exacerbated. If, on the other hand, efforts are made to eliminate the toxin, an improvement in the condition of the affected person can be achieved relatively quickly.
Prevention
Regulations that regulate the dispensing of bromide-containing drugs and do not allow free dispensing contribute to the prevention of bromism. If there is nevertheless an indication to take an appropriate drug, treating physicians perform regular blood and/or urine tests. These control tests detect elevated bromide levels in the blood at an early stage and allow intervention before the bromism manifests. In many cases, however, physicians often opt for other drugs with equivalent efficacy because of the poor risk-benefit ratio of bromine.
Follow-up
As a rule, direct aftercare is not possible with bromism. The patient’s body must recover from the poisoning, and the precipitating substance or procedure should be eliminated. Likewise, care must be taken to prevent the bromism from recurring. Since there is also no direct treatment method for bromism, the first and foremost thing to do is to stop the bromine intake. Furthermore, the patient should consume plenty of fluids and generally pay attention to a healthy lifestyle with a healthy diet. Likewise, the excretion of bromine can be accelerated with the help of fluorine. However, in emergencies or in case of very severe and acute poisoning, the hospital should be visited, as treatment by a physician is necessary. Of course, the supply of bromine should not be completely stopped after a bromism, since the body also needs the trace element. However, the intake should be in small amounts through ordinary foods. Likewise, the affected person should refrain from nicotine and from alcohol, as this also causes increased amounts of bromine to be ingested. Painkillers should also be discontinued if this is possible. As a rule, the patient’s life expectancy is not reduced by bromism if it is diagnosed and treated in time.
What you can do yourself
There are no specific orthodox or alternative therapies against bromism poisoning. For the purpose of treatment, the source of poisoning is identified and eliminated. Here, the physician is urgently dependent on the cooperation of the patient. Bromism in infants is usually due to contaminated breast milk. In these cases, breastfeeding must be stopped immediately and bottle feeding given instead. Adults can prevent poisoning by strictly adhering to the dosage instructions for bromine-containing drugs. This is especially true if bromine-containing sedatives have been prescribed. Under no circumstances should these medications be hoarded and taken at one’s own discretion. Patients with symptoms of dependence should definitely seek help from an addiction support program. Chloride and fluoride are thought to promote the excretion of bromide from the body. In naturopathy, these substances are therefore used to detoxify the body. Increased fluid intake, especially in the form of diuretic healing waters, is also thought to be helpful in eliminating bromide as quickly as possible. Patients should absolutely refrain from ingesting substances that put additional strain on the body, such as alcohol or nicotine, during acute bromide poisoning. The use of over-the-counter medications, such as painkillers, should also be discussed with the attending physician.
