BROMIDES

Drugs in Pregnancy and Lactation.

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Name: BROMIDES
Class: Anticonvulsant/Sedative
Risk Factor:    D

Fetal Risk Summary

The Collaborative Perinatal Project monitored 50,282 mother-child pairs, 986 of which had 1st trimester exposure to bromides (1, pp. 402–406). For use anytime during pregnancy, 2,610 exposures were recorded (1, p. 444). In neither group was evidence found to suggest a relationship to large categories of major or minor malformations. Four possible associations with individual malformations were found, but the statistical significance of these is unknown and independent confirmation is required: Polydactyly (14 cases) Gastrointestinal anomalies (10 cases) Clubfoot (7 cases) Congenital dislocation of hip (use anytime) (92 cases) Two infants with intrauterine growth retardation from a mother who chronically ingested a proprietary product containing bromides (Bromo-Seltzer) have been described (2). Both male infants were microcephalic (one at the 2nd percentile and one at less than the 2nd percentile) and one had congenital heart disease (atrial septal defect with possible pulmonary insufficiency). The mother did not use the product in three other pregnancies, two before and one after the affected children, and all three of these children were of normal height. In a similar case, a woman chronically ingested tablets containing bromides throughout gestation and eventually gave birth to a female infant who was growth retarded (all parameters below the 10th percentile) (3). Follow-up of the infant at 2.5 years of age indicated persistent developmental delay.

Neonatal bromide intoxication from transplacental accumulation has been described in four infants (4,5,6 and 7). In each case, the mother had either taken bromide-containing medications (three cases) or was exposed from employment in a photographic laboratory (one case). Bromide concentrations in three of the four infants were 3650, 2000, and 2420 µg/mL on days 6, 5, and 5, respectively (4,5 and 6). In the fourth case, a serum sample, not obtained until 18 days after birth, contained 150 µg/mL (7). All four infants exhibited symptoms of neonatal bromism consisting of poor suck, weak cry, diminished Moro reflex, lethargy, and hypotonia. One of the infants also had cyanosis and a large head with dysmorphic face (7). Subsequent examinations of three of the above infants revealed normal growth and development after several months (4,5 and 6). One infant, however, had mild residual hypotonia of the neck muscles persisting at 6 and 9.5 months (7).

Cord serum bromide levels were determined on 1,267 newborn infants born in Rochester, NY, during the first half of 1984 (8). Mean bromide concentrations were 8.6 µg/mL (range 3.1–28.5 µg/mL), well below the serum bromide level (>720 µg/mL) that is considered toxic (8). The measured concentrations were not related to Apgar scores, neonatal condition, or congenital abnormalities. None of the mothers was taking bromide-containing drugs (most of which have been removed from the market), and the concentrations in cord blood were thought to have resulted from occupational exposure to photographic chemicals or from the low levels encountered in food and water.

Breast Feeding Summary

The excretion of bromides into breast milk has been known since at least 1907 (9). A 1938 report reviewed this topic and demonstrated the presence of bromides in milk in an additional 10 mothers (9). A 1935 report measured milk concentrations of 1666 µg/mL in two patients treated with 5 g daily for 1 month (10). Rash and sedation of varying degrees in several nursing infants have been reported as a result of maternal consumption of bromides during lactation (9,10 and 11). Although bromide-containing medications are no longer available in the United States, these drugs may be available in other countries. In addition, high maternal serum levels may be obtained from close, frequent exposure to chemicals used in photographic developing. Women who are breast feeding and are exposed to such chemicals should be alert for symptoms of sedation or drowsiness and unexplained rashes in their infants. Monitoring of bromide levels in these women may be beneficial. Breast feeding is not recommended for women receiving bromide-containing medications, although the American Academy of Pediatrics considers bromides to be compatible with breast feeding (12).

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World’s leading meds delivered to your door – and you don’t even need a prescription! Only certified, first class drugs on offer! Buy more and spend less with our great discount system.

References

  1. Heinonen OP, Slone D, Shapiro S. Birth Defects and Drugs in Pregnancy. Littleton, MA:Publishing Sciences Group, 1977.
  2. Opitz JM, Grosse RF, Haneberg B. Congenital effects of bromism? Lancet 1972;1:91–2.
  3. Rossiter EJR, Rendel-Short TJ. Congenital effects of bromism? Lancet 1972;2:705.
  4. Finken RL, Robertson WO. Transplacental bromism. Am J Dis Child 1963;106:224–6.
  5. Mangurten HH, Ban R. Neonatal hypotonia secondary to transplacental bromism. J Pediatr 1974;85:426–8.
  6. Pleasure JR, Blackburn MG. Neonatal bromide intoxication: prenatal ingestion of a large quantity of bromides with transplacental accumulation in the fetus. Pediatrics 1975;55:503–6.
  7. Mangurten HH, Kaye CI. Neonatal bromism secondary to maternal exposure in a photographic laboratory. J Pediatr 1982;100:596–8.
  8. Miller ME, Cosgriff JM, Roghmann KJ. Cord serum bromide concentration:variation and lack of association with pregnancy outcome. Am J Obstet Gynecol 1987;157:826–30.
  9. Tyson RM, Shrader EA, Perlman HH. Drugs transmitted through breast milk. III. Bromides. J Pediatr 1938;13:91–3.
  10. Kwit NT, Hatcher RA. Excretion of drugs in milk. Am J Dis Child 1935;49:900–4.
  11. Van der Bogert F. Bromin poisoning through mother's milk. Am J Dis Child 1921;21:167.
  12. Committee on Drugs, American Academy of Pediatrics. The transfer of drugs and other chemicals into human milk. Pediatrics 1994;93:137–50.

Index

Q&A about Bromides

firefigh...
how many secondary alkyl bromides exist in the formula C6H13Br?
Top Gun
One

CH3-CH2-CH2-CH2-CHBr-CH3
lilj1130
what are flourides, chlorides, bromides and iodides?
this is homework please help.
Dr Dave P
Fluorine is a gas. (If you breath it you will die) yellowish gas

Chlorine is a gas. (If you breath it you will die) greenish gas

Bromine is a liquid. If you get it on you skin it wil burn you) - it's a brown liquid.

Iodine is a solid - it sublimes at room temperature. (deep-purple in solutions)

All are toxic - but iodine is used as an antiseptic for cuts and abrasions of human skin - so it is the least toxic of the bunch.

All exist as diatomic forms F2,Cl2, Br2, and I2.

Although variations aren't uncommon for example, I-Br.
Michelle Mathai
The addition of sodium or potassium iodide catalyzes many SN2 rxns of alkyl chlorides or bromides. Explain.?
Farooq
First of all SN2 reaction is a reaction type in which the leaving group (LG) and the nucleophile (Nu) are involved both at once. The Nu attacks the carbon as the LG leaves. Almost always the LG would have the negative charge (due to an extra electron).

The reason Sodium or Potassium Iodide help (or catalyze) this reaction is because positively charged Sodium and Potassium will aid in the leaving process of LG thus making it easier for the Nu to attack and replace the LG.

The iodide ion is a very weak base and very stable in its ion form so it will remain in the solutiono without interacting with anything.
****KIA*...
How long after you add bromide tablets for the first time and shock a hot tub can you test the water?
How long after I put a bromide floater in and also shock for the first time should I wait to test and adjust the levels if needed? How long for a reliable result?
Dr. Hot Tub Wilmington NC
Put your bromine feeder in and maintain a level of 3-5ppm. Wait about 2 hours after shocking before testing again.

Perhaps you might start thinking about a non-chlorine shock.

How are you testing is the real question. Reagents can be inaccurate and so can test strips. There is a major test right now in the works to hopefully give us some answers.

Since your so sure of yourself Froggy feel free to email me with your hotel info. and city and we will see exactly what can happen. Looking at your disregards for the NSPF and most likely the APSP I wonder where you get your training for proper water sanitation since that is the most important thing for your guests.

(Laughing)...Kippy Jane you better make sure you correct your answer or the Engineer might tell you, you have no "edumacation" like he did me! To think I wasted 138k on a graduate degree. Oops! Good thing this poor pool/spa thing makes incredible money other wise I might not be able to afford my houses. Sir your the one that insulted my education because of my first answer I wrote in the middle of the night. I bring up my education above since you insulted me and brought it up yourself and as Kippy said you also insulted the asker of the question in reference to Bromide. This might be fun and games to you but improper santitation of water can lead to some very serious health issues and even death. This needs to be taken very seriously.

Impressive new answer Froggy. So why not email me your info and stand behind your knowledge?

Apparently his answer is not so great for Yahoo answers, since it is no long visible. With your negative endorsement it further proves your ignorance.
Abdallah A
How does the water / lithium-bromide absorption cooling process work?
I fully know and understand how the Ammonia / Water absorption process works.

I even understand how the Ammonia / Calcium Chloride absorption process works.

But in their case, Ammonia is the refrigerant. It has a boiling point of -33 Degrees Celsius. It's understandable that when it evaporates, it takes away heat.

But in the water / lithium-bromide process, water is the refrigerant. I understand that the pressure is lowered to allow the water to evaporate, but how cold can it get? Will it bring down the temperature of the surrounding area to freezing?

Also, if pressure is brought down, what kind of piping is used? Doesn't it have to be strong to withstand the pressure being much higher on the outside than the inside?
gatorbai...
see the following article.....be sure to read the "Next" page on this article also for a working diagram of the system.

http://www.tpub.com/content/fc/14104/css...
narfinat...
What is the correct formula for lithium bromide?
What is the correct formula for lithium bromide? I have tried to figure it out but I can't seem to get the right answer.
satyam
why don't you try on google?
MagicGir...
What visible reaction occurs when chlorine water is mixed with sodium bromide solution?
For a lab report, I need to know what the visible reaction of 2Cl + NaBr is. I know the formula, but I can't remember what the reaction looked like. All I remember is that we were supposed to get 2 aqueous layers of different colors. I would also appreciate a physical description of the reactions of 2Cl + NaI and 2Br + NaI.
ETAdvanc...
The chlorine water will oxidize the bromide ion to bromine, which is brownish colored liquid or vapor.

Similarly, bromine will oxidize iodide to from iodine which is a violet colored solid.

Depending on the concentrations, the bromine or iodine can separate from the solution, but there would be only 1 aqueous layer.

Both these reactions are examples of oxidation-reduction reactions (the bromide ion or iodide ion is getting oxidized and the HClO or Cl2 or Bromine is getting reduced)
****KIA*...
Hot Tub Question - Should I open the floater with bromide tablets all the way or not?
I just set up a small hot tub and shocked it and added a bromide tablet floater to the tub. The floater has an adjustment on it and I wonder how much I should have it open?
pcbeachr...
I use only 2 holes open for a small 4 person hot tub..Start out at 1 or 2 then adjust as time goes on to fit your tub..all the way open will more than likely be way to strong..It's easier to increase the adjustment you set than to decrease it(which you cant) after you have too much coming in..try the second hole for a day or so..then if it doesnt seem fit go 1/2 a hole at a time..whith too many holes open your eyes will start slightly burning...