Bromism from excessive cola consumption

J Toxicol Clin Toxicol. 1997;35(3):315-20. doi: 10.3109/15563659709001219.


Background: Bromism is an unusual occurrence. Historically bromism has been known to occur with chronic ingestion of bromide salts used as sleep medications. In this case, excessive consumption of a cola with brominated vegetable oil caused a severe case of bromism.

Case report: The patient presented with headache, fatigue, ataxia, and memory loss which progressed over 30 days. He consumed 2 to 4 L of cola containing brominated vegetable oil on a daily basis before presenting with these symptoms. His significantly elevated serum chloride, as measured by ion specific methods, and negative anion gaps were overlooked during a prior hospitalization and emergency department visits. A focal neurologic finding of right eyelid ptosis led to an extensive evaluation for a central nervous system lesion. The patient continued to deteriorate, until he was no longer able to walk. A diagnosis of severe bromism was eventually made and his serum bromide was confirmed at 3180 mg/L (39.8 mmol/L). Despite saline loading the patient failed to improve but subsequent hemodialysis dramatically cleared his clinical condition, and reduced his serum bromide levels. The unilateral eyelid ptosis, a rarely reported finding in bromism, also resolved with hemodialysis.

Conclusions: A negative anion gap or an elevated serum chloride should prompt an evaluation for bromism. In this case hemodialysis dramatically improved the patient's clinical condition and reduced the half-life of bromide to 1.38 h.

Publication types

  • Case Reports

MeSH terms

  • Acid-Base Equilibrium
  • Adult
  • Ataxia / chemically induced
  • Attention / drug effects
  • Beverages / adverse effects*
  • Bromides / adverse effects*
  • Bromides / pharmacokinetics
  • Chlorides / blood
  • Drug Overdose
  • Fatigue / chemically induced
  • Half-Life
  • Headache / chemically induced
  • Humans
  • Magnetic Resonance Imaging
  • Plant Oils / adverse effects
  • Plant Oils / chemistry
  • Renal Dialysis
  • Tomography, Emission-Computed


  • Bromides
  • Chlorides
  • Plant Oils