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Myoclonic jerks due to acute bromovalerylurea intoxication
Jiun-Nong Lin1, Hsing-Lin Lin, Chun-Kai Huang
1Department of Internal Medicine, E-Da Hospital/I-Shou University, Jiun-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan, Republic of China.
Clinical Toxicology (Philadelphia, Pa.)
|August 1, 2008
Summary
Acute bromovalerylurea intoxication can cause severe myoclonic jerks and lethargy. This case highlights the importance of considering bromide intoxication in patients presenting with myoclonic jerks, with saline and diuretics proving effective treatment.
Area of Science:
- Toxicology
- Neurology
- Pharmacology
Background:
- Bromides, including bromovalerylurea, are used as sedatives and anticonvulsants globally.
- Over-the-counter products sometimes combine bromovalerylurea with NSAIDs.
- Chronic excessive intake can lead to bromide intoxication, but acute presentations are less documented.
Observation:
- A 23-year-old woman presented with severe drowsiness and myoclonic jerks.
- Her serum bromide concentration was significantly elevated at 81.0 mg/L.
- Brain MRI was normal, ruling out structural abnormalities.
Findings:
- This case describes the first instance of acute bromovalerylurea intoxication presenting with myoclonic jerks.
- Treatment with intravenous normal saline and furosemide rapidly improved symptoms.
- Serum bromide levels normalized, and the patient recovered without neurological sequelae.
Implications:
- Myoclonic jerks can be a key indicator of acute bromovalerylurea intoxication.
- Physicians should include bromide intoxication in the differential diagnosis for myoclonic jerks.
- Saline and diuretic therapy effectively increases bromide clearance and clinical improvement.
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