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August 7, 1943


Author Affiliations

4 Hillhouse Avenue, New Haven, Conn.

JAMA. 1943;122(15):1033. doi:10.1001/jama.1943.02840320051020

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To the Editor:—  In the June 19 issue of The Journal Dr. J. M. Nielsen reports a case of bromidism attributed to excessive use of prostigmine bromide in myasthenia gravis. The author of the report is, as he states, aware of the fact that the amount of bromide taken was small but that even with the small dose such an accumulation resulted that a blood concentration of 225 mg. per hundred cubic centimeters was eventually reached. The author explains this remarkable accumulation on the ground that for any dosage of bromide the concentration in the blood shows enormous individual variations.On the contrary, it has been thoroughly demonstrated that the accumulation of bromide depends on definite physical characteristics and physiologic functions: dosage in relation to body weight, volume of extracellular fluid and rate of excretion of sodium chloride. The accumulation shows no greater individual variations than those of these characteristics

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