When bromism is a chronic poisoning, which is caused by long-term intake of bromides. At an advanced stage, bromism leads to dark spots on the skin and excessive emaciation.
What is bromism
According to DigoPaul, bromism describes chronic bromine poisoning. In the past it was one of the most common diseases in Europe. Especially among psychiatric patients there were many people 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 diseases. 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 sick people decreased significantly, as drugs with bromine compounds were prescribed less often.
Doctors still value bromine today because of its effect as a sedative and use it, for example, to treat epileptic seizures, which, if taken incorrectly, can cause bromine poisoning. Correct dosage is therefore of great importance.
Bromine acts on the nervous system and causes bromism if poisoned. The symptoms arise from a disruption of the membranes of the nerve cells by the bromides. As a rule, the human body absorbs bromine through appropriate drugs that were previously widely used and were wrongly considered harmless. Even today, bromine is still used as a drug in pharmacy.
However, drugs containing bromine have been subject to prescription requirements 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 taking the drug before bromism develops. Infants can also develop bromism, especially if they ingest bromine from breast milk.
In addition, it should now be possible to release bromine through waste incineration or via insecticides. As an environmental toxin, it could therefore enter the organism via the skin, the respiratory tract or indirectly through contaminated food. It is questionable, however, whether this will lead to sufficient amounts in the human body to cause bromism. Bromides occur in higher quantities in lithium bromide, which is used for cooling in absorption chillers.
Symptoms, ailments & signs
Bromism manifests itself in various neurological and psychological symptoms. These include seizures and somnolence, a quantitative disorder of consciousness. This slight clouding of consciousness describes a relative impairment of wakefulness (vigilance). Somnolence manifests itself as drowsiness and drowsiness that are beyond the normal range.
Other psychiatric symptoms that may appear are agitation, irritation, hallucinations, tremors, insomnia and psychotic symptoms. Other signs of bromism include weakness, drowsiness, difficulty concentrating, and a coma. As the most severe quantitative disturbance of consciousness, coma is differentiated from somnolence in that those affected can neither be addressed nor woken up.
If a stupor occurs in the context of bromism, the person concerned suffers from paralysis of the whole body while he is unclouded. Also, ataxia, ie a disturbance of coordination of movements, may indicate bromism. In addition, gastrointestinal symptoms such as loss of appetite and vomiting can occur with bromism.
Diagnosis & course
An examination of the person’s blood or urine enables the diagnosis to be made, as it provides information about the amount of bromine in the body. In addition, an X-ray examination of the abdomen can bring clarity: Since bromides do not let X-rays through, this is a clear indication of bromides in the person’s body.
In addition, bromism is usually associated with disorders of the blood values for glucose, creatine and electrolytes, which can provide an initial indication even without a specific examination for bromides. Without treatment, the symptoms of bromism worsen and general health worsens. In the advanced course of bromism, the clearly visible bromine acne can occur. These are small abscesses that leave pigmented scars as they heal. In some cases, bromoderm can develop from bromine acne without treatment. Blistering characterizes the form Bromoderma bullosum.
If the bromoderm manifests itself as ulcerated granulation from brown to black-red color, the medicine speaks of bromoderma tuberosum. This form of bromoderm also heals with a pigmented scar. Graphic representations of bromism therefore often show people with dark patches of skin. Due to persistent poisoning, bromism can also lead to physical exhaustion symptoms (cachexia).
Bromism can lead to various complications. Bromide poisoning first affects the membranes of neurons, which increases the risk of psychosis and somnolence. Depending on the severity of the bromism, the result is irritation, drowsiness and hallucinations, but also fatigue and symptoms of paralysis. In extreme cases, bromide poisoning can lead to coma or death.
In addition to these disturbances in 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 do skin symptoms such as “bromine acne” occur, which are accompanied by painful pustules, itching and typical fever symptoms. Other possible complications of bromism are: painful breathing, ataxia, and stupor.
In the case of movement disorders and symptoms of paralysis, further complications can arise later. Since bromism mainly occurs in infants and young children, there is a risk that the symptoms will develop into permanent developmental disorders. A chronic course can also lead to the formation of scars and chronic infections. If bromism is detected early, serious complications can usually be avoided.
When should you go to the doctor?
Some symptoms of bromism are so serious that in most cases those affected or those around them will call a doctor without knowing it is bromism. This is the case, for example, with the onset of stupor, coma or bromine acne. In addition, seizures, persistent nausea or psychoses cause those affected or those around them to act.
Since bromism has become rare and almost unknown among younger people, it is important to clarify the symptoms precisely – which can also occur in a similar way with other types of poisoning. For this, the person concerned should be admitted to a hospital.
People who suffer from increased nausea, cramps, skin irritation, hallucinations or other symptoms of bromism should consult a doctor who can draw initial conclusions based on a medical history. In rare cases, drugs or high levels of bromine exposure can still trigger bromism. Salts containing bromine are also increasingly being used again as anticonvulsants (to treat seizures).
Children with symptoms of bromism should be urgently examined by a doctor as they are more sensitive to poisoning. If the babies are breastfed, the mother should also be examined, as the milk can be contaminated.
Treatment & Therapy
There is no specific treatment for bromism. It is essential to reduce the ingested dose or to stop taking bromine-containing drugs. Although there is no specific antidote, chloride and fluoride are believed to tend to promote the excretion of bromide. Furosemide treatment can also be considered for bromism. It is a loop diuretic that promotes the excretion of fluids.
As a result, the body may be able to excrete the bromine more quickly. Various companies manufacture furosemide and sell it under their respective trade names. Since it is a highly effective loop diuretic, which can sometimes have serious side effects, it may only be taken on the advice of a doctor.
Outlook & forecast
Bromism allows very different prognoses. Children, for example, suffer more from the long-term effects than adults, as children can still develop disorders (mostly caused by infections caused by damage to the skin and damage to the central nervous system).
None of the symptoms associated with bromism are on their own fatal. However, it is precisely the many skin changes and the weakening of the gastrointestinal tract that lead to emaciation of the body. Long-lasting digestive disorders and nausea are not uncommon. The resulting nutrient deficiency, in combination with the constant increased stress on the body from the other symptoms of intoxication, then leads to a weakening of the whole person.
While the skin changes and the restrictions 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 for the person concerned then means that he is a need for care, other effects – especially those of a psychological nature – do not necessarily have an effect on life expectancy.
If bromine continues to enter the body, the bromism will increase. If, on the other hand, efforts are made to discharge the poison, an improvement in the condition of the person affected can be achieved relatively quickly.
Regulations that regulate the dispensing of drugs containing bromide and do not allow free dispensing contribute to the prevention of bromism. If there is nevertheless an indication for the use of a corresponding medication, the treating physicians will carry out regular blood and / or urine tests.
These check-ups detect elevated bromide levels in the blood at an early stage and allow action to be taken before the bromism manifests itself. In many cases, however, due to the poor risk-benefit ratio of bromine, doctors often choose other drugs with the same effect.
As a rule, direct follow-up care for bromism is not possible. The patient’s body must recover from the poisoning and the offending substance or agent should be eliminated. Care must also be taken that the bromism does not recur. Since there is no direct treatment method for bromism either, the bromine uptake must first and foremost be interrupted.
Furthermore, the patient should drink plenty of fluids and, in general, follow a healthy lifestyle with a healthy diet. The excretion of bromine can also be accelerated with the aid of fluorine. In emergencies or in the case of very severe and acute poisoning, however, the hospital should be visited as treatment by a doctor is necessary.
The supply of bromine must of course not be completely interrupted after bromism, since the body also needs the trace element. However, they should be consumed in small quantities through normal foods. Likewise, the person concerned should refrain from nicotine and alcohol, as this also increases the amount of bromine consumed.
Painkillers should also be stopped if possible. As a rule, bromism does not reduce the patient’s life expectancy if it is diagnosed and treated in a timely manner.
You can do that yourself
There are no special conventional medical or alternative therapies against poisoning with bromine. For treatment, the source of the poisoning is identified and eliminated. Here the doctor urgently needs 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-fed formula administered instead. Adults can prevent poisoning by strictly following the dosage instructions for drugs containing bromine.
This is especially true if sedatives containing bromine have been prescribed. Under no circumstances may these drugs be hoarded and taken as you see fit. Patients with addiction symptoms should definitely seek out an addiction support program.
Chloride and fluoride are said 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 medicinal waters, is also considered to be helpful in excreting the bromide as quickly as possible.
Patients should definitely refrain from ingesting substances that put additional stress on the body, such as alcohol or nicotine, during acute poisoning with bromine. The use of over-the-counter medication, such as pain relievers, should also be discussed with the attending physician.