Document Detail


Myoclonic jerks due to acute bromovalerylurea intoxication.
MedLine Citation:
PMID:  18668386     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Bromides are still sold as sedatives, antitussives, and anticonvulsants in many countries. Bromovalerylurea is a bromide-containing sedative-hypnotic that is occasionally combined with non-steroidal anti-inflammatory drugs in over-the-counter products. Chronic intake of excessive bromovalerylurea can produce bromide intoxication, but acute bromovalerylurea intoxication presenting with myoclonic jerks has never been described. CASE REPORT: A 23-year-old woman was brought to our emergency department with unusual drowsiness. Her physical examination was normal except for frequent myoclonic jerks in all extremities that could be triggered by moving the patient or by noxious stimuli. Initial blood tests results were normal; the serum bromide concentration was 81.0 mg/L (reference <10 mg/L). Treatment with intravenous normal saline and furosemide resulted in gradual improvement in her drowsiness and myoclonic jerks. By the second hospital day, she was normal. A brain magnetic resonance imaging (MRI) was normal. At a 2-month follow-up visit, the patient had no neurological sequelae. DISCUSSION: Chronic bromide intoxication caused by long-term abuse of bromovalerylurea may present as psychiatric or neurologic abnormalities. Our case of acute bromovalerylurea intoxication presented with severe myoclonic jerks and lethargy. The serum bromide concentration was similar to the reported concentrations in acute bromide intoxications. Treatment with normal saline and diuretics results in increased clearance of bromide and an improvement in clinical effects. CONCLUSION: Myoclonic jerks may be one of the major presentations of acute bromovalerylurea intoxication. Physicians should consider bromide intoxication in the differential diagnosis of the causes of myoclonic jerks.
Authors:
Jiun-Nong Lin; Hsing-Lin Lin; Chun-Kai Huang; Chung-Hsu Lai; Hsing-Chun Chung; Shiou-Haur Liang; Hsi-Hsun Lin
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Clinical toxicology (Philadelphia, Pa.)     Volume:  46     ISSN:  1556-9519     ISO Abbreviation:  Clin Toxicol (Phila)     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-11-12     Completed Date:  2008-12-01     Revised Date:  2009-11-17    
Medline Journal Info:
Nlm Unique ID:  101241654     Medline TA:  Clin Toxicol (Phila)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  861-3     Citation Subset:  AIM; IM    
Affiliation:
Department of Internal Medicine, E-Da Hospital/I-Shou University, Jiun-Shu Tsuen, Yan-Chau Shiang, Kaohsiung County, Taiwan, Republic of China.
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MeSH Terms
Descriptor/Qualifier:
Bromine / blood
Bromisovalum / poisoning*
Diuretics / therapeutic use
Female
Follow-Up Studies
Furosemide / therapeutic use
Humans
Hypnotics and Sedatives / poisoning*
Myoclonus / chemically induced*
Sodium Chloride / therapeutic use
Suicide, Attempted
Young Adult
Chemical
Reg. No./Substance:
0/Diuretics; 0/Hypnotics and Sedatives; 496-67-3/Bromisovalum; 54-31-9/Furosemide; 7647-14-5/Sodium Chloride; 7726-95-6/Bromine
Comments/Corrections
Comment In:
Clin Toxicol (Phila). 2009 Apr;47(4):371-2; author reply 372   [PMID:  19360507 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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