Related Experiment Video
Updated: Jul 6, 2026
02:26
Intracranial Pharmacotherapy and Pain Assays in Rodents
Published on: April 9, 2019
Bromism caused by mix-formulated analgesic injectables.
P F Hsieh1, Y T Tsan, D Z Hung
1Department of Internal Medicine, Division of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan, Republic of China.
Human & Experimental Toxicology
|April 1, 2008
Summary
Chronic bromide intoxication (bromism) from pain injections is a newly identified risk. This study reports a case and highlights the continued use of bromide-containing injectables in Taiwan, urging clinical awareness.
Area of Science:
- Pharmacology
- Clinical Toxicology
Background:
- Bromism, a form of chronic bromide intoxication, is typically associated with various medications.
- Injectable pain-relief medications have not been previously reported as a cause of bromism.
Observation:
- A case of bromism in a 25-year-old female presenting with forgetfulness and gait instability after long-term use of injectable pain medication.
- Analysis revealed severe hyperchloremia (171 mEq/L), a negative anion gap (-48.7 mEq/L), and elevated serum bromide levels (2150 mg/L).
Findings:
- The patient recovered fully within 3 days following saline treatment.
- Internet searches confirmed the availability of injectable medications containing significant amounts of sodium bromide (up to 1000 mg/ampoule) or calcium bromide (up to 800 mg/ampoule) in Taiwan.
- Many analgesic/antipyretic and antihistamine injections containing bromides remain in use in Taiwan.
Implications:
- Clinicians must be vigilant regarding the potential for iatrogenic bromism from injectable medications.
- Increased awareness is crucial to prevent misdiagnoses and ensure patient safety.
- This study underscores the need to re-evaluate the continued use of bromide-containing injectable formulations.
Related Concept Videos
01:15Opioid Analgesics: Synthetic and Semisynthetic Opioids
Synthetic and semisynthetic opioids are pivotal in pain management and tackling opioid addiction. Semisynthetic opioids, including morphinans (morphine derivatives), oxycodone, oxymorphone, hydrocodone, and hydromorphone, have improved pharmacokinetic profiles compared to morphine. Additionally, heroin and 6-MAM (6-Monoacetylmorphine) show better CNS penetration than morphine due to heightened lipid solubility. Hydromorphone, a potent opioid, undergoes hepatic metabolism to form the active...
01:22Drug Delivery: Miscellaneous Routes
Drug delivery methods like oral inhalation, nasal sprays, transdermal patches, eye drops, intravitreal injection, and rectal administration provide localized effects with reduced toxicity.
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs through the...
Oral inhalation and nasal sprays swiftly transfer drugs across the respiratory epithelium's mucosal layer. Inhaled glucocorticoids and bronchodilators directly target lung conditions such as asthma, while fluticasone nasal spray mitigates allergic rhinitis.
Transdermal patches transport drugs through the...
01:29Drug Delivery: Parenteral Route
The parenteral route is a critical method of drug administration. It delivers compounds directly into the systemic circulation and bypasses the gastrointestinal tract. This approach is particularly advantageous for drugs that exhibit poor absorption or instability when administered orally.
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
There are three primary parenteral routes: intravenous (IV), intramuscular (IM), and subcutaneous (SC). The IV route introduces the drug directly into the bloodstream, ensuring immediate action. The IM route...
01:21Skeletal Muscle Relaxants: Adverse Effects
Skeletal muscle relaxants are widely used for muscle paralysis and relieving pain following any muscle injury or stiffness. However, depending on the drug type, they can have adverse effects that range from mild to severe. Usually, nondepolarizing neuromuscular blockers have minimal side effects. For example, drugs like d-tubocurarine, cisatracurium, and rocuronium cause hypotension, whereas drugs like baclofen, when stopped abruptly, can lead to the recurrence of spastic conditions.
Unlike...
Unlike...
01:24Parenteral Anesthetics: Overview
Intravenous anesthetics are drugs administered parenterally to induce anesthesia or sedation. Propofol is a widely used agent formulated as a 1% emulsion in soybean oil, glycerol, and egg phosphatide. It induces rapid anesthesia primarily due to its rapid distribution from the bloodstream to target tissues and is metabolized in the liver. However, it can cause significant pain on injection and hypertriglyceridemia. Fospropofol, a water-based prodrug of propofol, lacks these adverse effects.
01:30Toxidromes: Clinical Features
Toxidromes are specific patterns of symptoms resulting from toxic substance exposure. They help in the identification and treatment of poisoning. The symptoms of each toxidrome group indicate poisoning by a certain class of chemicals or drugs.1. Sympathomimetic: Stimulates the sympathetic nervous system. Symptoms include agitation, increased heart rate (HR), blood pressure (BP), respiratory rate (RR), temperature, and pupil size. Drugs like cocaine and amphetamines, along with tremors and...