Clinical and forensic toxicology of bromism and bromoderma: mechanisms, diagnosis, and treatment

Bromism is a syndrome that results from bromide intoxication. It is difficult to diagnose since it mimics a myriad of psychiatric and dermatological disturbances. Historically, the most common sources have been drug ingestion or contaminated drinks. This work aims to thoroughly review all the state-of-the-art aspects of bromism and bromoderma, including its pathophysiology, diagnosis, treatment, and other relevant clinical and forensic features. In this context, a comprehensive search was conducted in PubMed (U.S. National Library of Medicine) without time restrictions. Bromism may occur in individuals of any age or gender, but it is more frequent in women. In children, it usually occurs under therapy for resistant epilepsy or is breastfed by mothers who ingested bromide and may manifest as bromoderma. In adults, bromism manifests with psychiatric and neurological signs such as hallucinations, delusions, or ataxia. Pseudohyperchloremia with a negative anion gap is highly suggestive of the diagnosis. Treatment requires the removal of bromide, which is achieved by per os or intravenous saline administration or even hemodialysis. Although bromism is not usually observed in clinical and forensic practice, it is still related to the administration of controlled or immediate-release formulations, mainly analgesics or antiepileptic drugs, as well as internet-purchased supplements.