Ammonium Bromide Poisoning

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Ammonium bromide is the ammonium salt of hydrobromic acid. It crystallizes in colorless prisms and has a saline taste; it sublimes on heating and is readily soluble in water. It is used as a preservative and for fireproofing wood, in photographic films, plates and papers, in lithography and process engraving, and as a corrosion inhibitor. It is also used in the manufacture of dyes, textiles and pharmaceutical preparations.

In addition to sedative and anticonvulsant effects, it produces a variety of neuropsychiatric changes. Patients who are referred to psychiatric institutions often have bromide intoxication. Signs and symptoms of bromide intoxication (bromism) include mental dullness, slurred speech, memory loss, anorexia, constipation, weight loss, loss of sensitivity to touch and pain, drowsiness, apathy and restlessness. Symptoms worsen with continued use and may progress to restlessness, confusion, hallucinations, delirium and coma.

This case illustrates the need for clinicians to consider ammonium bromide poisoning in the differential diagnosis of sedative-hypnotic-type intoxication. Elevations in serum chloride levels and a negative anion gap are helpful features that can help in the differentiation of this disorder, but our patient did not have either feature. In the absence of these clinical findings, aggressive hydration with chloride-containing solutions and a high level of suspicion remain essential in the management of this disorder. The chemical data in CAMEO Chemicals are free of copyright restrictions in the United States and can be reused without permission. For further information, see the CAMEO Chemicals Citation Policy.