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David M. Rothenberg, MD; Arnold S. Berns, MD; Robert Barkin, PharmD; Russell H. Glantz, MD

JAMA. 1990;263(8):1121-1122.

Abstract
The diagnosis of bromide intoxication is often aided by the detection of a low or negative anion gap due to the laboratory detection of bromide as chloride. A 59-year-old woman with myasthenia gravis who received a large dose of pyridostigmine bromide developed postoperative psychosis and was diagnosed as having bromide intoxication. The diagnosis was suspected in the setting of a negative anion gap and only later confirmed by direct measurement of the serum bromide level. To our knowledge, this is the first reported case of bromide intoxication due to pyridostigmine bromide administration.

(JAMA. 1990;263:1121-1122)

Author Affiliations
From the Departments of Anesthesiology (Drs Rothenberg and Barkin) and Neurology (Dr Glantz), Rush Medical College, Rush-Presbyterian—St Luke's Medical Center, Chicago, Ill: and the Department of Nephrology, St Francis Hospital, Evanston, III (Dr Berns).

Footnotes
Reprint requests to Department of Anesthesiology, Rush-Presbyterian—St Luke's Medical Center, Jelke 739, 1653 W Congress Pkwy, Chicago, IL 60612 (Dr Rothenberg).

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