JOURNAL ARTICLE

A case report of elevated bromide levels from pyridostigmine bromide for treatment of myasthenia gravis.

  • Published In: American Journal of Health-System Pharmacy, 2025, v. 82, n. 1. P. 12 1 of 3

  • Database: Academic Search Ultimate 2 of 3

  • Authored By: Defayette, Aubrey; Anibaldi, Elizabeth; Abad, Ajay; Ibegbu, Chinazom; Silvestri, Nicholas; Doobay, Ravi 3 of 3

Abstract

This article focuses on a case report of elevated serum bromide levels causing neurological symptoms in a patient treated with therapeutic doses of pyridostigmine bromide (PB) for myasthenia gravis. Bromide toxicity, or bromism, can produce neurological, gastrointestinal, and dermatological abnormalities and may interfere with chloride assays, leading to falsely elevated serum chloride and a low or negative anion gap. The patient experienced acute agitation with a bromide level of 37 μg/mL—below previously reported toxic levels—but no other causes for his symptoms were identified. The report highlights the need to consider bromide toxicity in patients on PB, monitor bromide levels despite delayed laboratory turnaround, and consult neurology to manage PB dosing when toxicity is suspected.

Additional Information

  • Source:American Journal of Health-System Pharmacy. 2025/01, Vol. 82, Issue 1, p12
  • Document Type:Article
  • Subject Area:Health and Medicine
  • Publication Date:2025
  • ISSN:1079-2082
  • DOI:10.1093/ajhp/zxae241
  • Accession Number:181734637
  • Copyright Statement:Copyright of American Journal of Health-System Pharmacy is the property of Oxford University Press / USA and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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