BROMIDE ION EXPLANATION Inorganic bromide has not been previously evaluated by the JMPR, but the Meeting in 1966 established an ADI for man of 0-1.0 mg/kg bw, based on a minimum pharmacologically effective dosage in humans of about 900 mg of KBr, equivalent to 600 mg of bromide ion. Since then toxicological studies with animals as well as human volunteers have become available and are summarized and evaluated in this monograph. EVALUATION FOR ACCEPTABLE INTAKE BIOLOGICAL DATA Biochemical Aspects Absorption, distribution, and excretion Mice Single doses of an aqueous solution of 82Br-ammonium bromide were injected into tail veins of pregnant albino mice 2 days before parturition. The mice were sacrificed after 5 or 20 min, 1, 2, 4, 24 or 48 hrs and the distribution of the 82Br in the tissues of the dams and the foetuses had been studied by autoradiography. The distribution of 82Br was similar at the various time periods studied. The radioactivity was excreted slowly, which resulted in only slight decreases in concentration with increasing time periods. Blood levels remained high and exceeded those recorded for most organs and tissues. Bromide gradually accumulates in the central nervous system. The level in the thyroid was relatively high but did not exceed levels in the blood. Bromide showed transplacental passage and most of the radioactive bromide was found in the bones of the foetuses, but the level was not as high as in the cartilage of the dams (Söremark & Ullberg, 1960). Rats Thirty females Wistar SPF rats received diets containing 2000 ppm sodium bromide for 3 weeks. Mean bromide concentration at the beginning of the bromide administration was 0.55 ± 0.46 mmol/l. After the 3 weeks of bromide administration it was 8.57 ± 0.57 mmol/l. The animals were then divided into 5 groups. Group 1 received a normal diet and tapwater as drinking water; Group 2 was fed a "salt free" diet and tapwater as drinking water; and Groups 3, 4 and 5 received a "salt free" diet and drinking water containing various concentrations of NaCl. The resulting chloride intake was 91, 10, 28, 55 and 144 mg/day, respectively. Plasma bromide levels were determined in all rats after 1, 2, 3, 4, 9 and 14 days. Bromide half-lives varied from 2.5 days at high-chloride intake, via 3.5 days at normal dietary chloride intake, to 25 days at low-chloride intake (Rauws & van Logten, 1975). It can be concluded that since bromide half-life is about 10 times longer at a low-chloride intake than at the highest chloride intake, the accumulation level in the first case will be about 10 times higher than in the latter case. In the reproduction study, a third litter (F1c) in the first generation was used for the investigation of the transplacental transport of bromide. Bromide concentrations in the kidneys of corresponding dams and foetuses were found almost equal, showing the absence of a distinct placental barrier in the developing foetus. The accumulation of bromide was also studied in the 90-day toxicity rat studies (see "Short-term toxicity" section). After the administration of normal and low chloride diets plasma bromide concentrations rose to a plateau within 3 and 12 weeks, respectively. Except for the highest dose groups in both studies, these plateaus were directly proportional to the bromide concentration in the diet. The same levels were reached at bromide concentrations in the low chloride diet, which were about 10 times lower then in the normal chloride diet. In these experiments total halogenide levels (Cl- and Br-) remained the same in the normal diet study and were significantly decreased at the highest dose in the low chloride study only (van Logten et al., 1976; Rauws, 1983). Toxicological studies Special studies mutagenicity Sodium and ammonium bromide were studied in an Ames test with Salmonella typhimurium strains TA-98 and TA-100. At dose levels of 0.001-10 mg/plate, both with and without metabolic activation, no mutagenic effect was observed (Voogd, 1988). Special studies on reproduction In a 3-generation reproduction study (2 litters/generation) groups of Wistar rats (10 males and 20 females/group) were fed diets containing 0, 75, 300, 1200, 4800 or 19200 ppm NaBr. Observations included behaviour, growth, food and water consumption, leucocyte count and differentation, T3 and T4 levels in serum, bromide in blood and thyroid, litter size and weight, reproduction parameters as fertility, viability and lactation index, organ weights and macroscopic examination. Complete infertility was observed at the highest dose whereas at 4800 ppm the fertility as well as the viability of the offspring was significantly reduced. Therefore the second and third generations were bred only from the groups dosed at up to end including 1200 ppm. No treatment-related effects were observed in reproductive performance, viability and body weight of the offspring in these groups. Haematological examinations revealed significantly increased neutrophil count and decreased lymphocytes in F0 females at 19200 and 4800 ppm. Serum thyroxine concentrations (T4) were significantly decreased in F0 males at all dose groups and in F0 females at the 2 highest dose groups after 6 weeks of administration. After 12 weeks of administration similar effects were observed. Body and organ-weight determinations did not reveal a clear pattern of dose-related effects in the successive generations. Only relative adrenal weight was significantly reduced in F0 females at 4800 and 1200 mg/kg food. In order to investigate the reversibility of the observed effects, an additional litter was bred with parent animals fed a diet containing 19200 ppm NaBr for 7 months followed by a control diet for 3 months before mating. No differences were observed in breeding results in the "reversibility" study between control and exposed rats (van Leeuwen et al., 1983a; van Logten et al., 1979). Special studies on thyroid function and endocrine parameters Male Wistar rats (10 animals/group/period) were fed diets containing 0, 20, 75, 300 or 1200 ppm NaBr (purity 99.5%) for 4 or 12 weeks. An additional experiment using the same protocol with 0 and 19200 ppm NaBr was carried out. Observations included body weight, serum hormone concentrations, weight and histopathological examination of testes, thyroid and pituitary gland. Both latter organs were also studied immunocytochemically. Significantly decreased body weight was observed at the highest dose (19200 ppm) after 4 and 12 weeks of administration. Relative thyroid weight was significantly increased at 1200 mg ppm after 4 weeks and significantly increased at the highest dose group after both 4 and 12 weeks of administration. An activation of the thyroid gland and a decreased spermatogenesis in the testes was observed microscopically in the highest dose group after 4 as well as after 12 weeks. After 4 weeks of treatment T4 (thyroxine) levels were significantly decreased at 1200 and 19200 ppm. A significant decrease of T4 was also observed at the highest dose after 12 weeks. TSH (thyroid-stimulating hormone) levels were significantly increased at the highest dose both after the 4- and the 12- week treatment. Insulin levels were significantly increased and growth hormone (GH) (after 12 weeks), testosterone and corticosterone levels were decreased at the high dose level. It was postulated that NaBr acts directly on certain endocrine organs such as the thyroid, adrenals and testes, thereby inducing alterations in the pituitary gland by feedback mechanisms (van Leeuwen et al., 1983b; Loeber et al., 1983). In an experiment on the time dependency of the effect of bromide on the thyroid gland in rats, significantly decreased thyroxine concentrations were found as soon as 3 days after feeding diets containing 4800 or 19200 ppm NaBr. This decrease was observed and remained constant during an experimental period of 12 weeks (van Leeuwen et al., 1983a). The uptake of radiolabelled iodide by the thyroid was measured in a "chloride-free" experiment 6, 24 and 48 hours after a single intraperitoneal injection of iodine-131 to rats (g/group) fed diets containing 0, 125, 500 or 2000 ppm NaBr for 90 days. At levels of 125 ppm NaBr and greater the iodine uptake was increased (significantly at 500 ppm). At 500 ppm the uptake was greater than at 2000 ppm; in the latter group the release, measured between 24 and 48 hours, seemed to be enhanced compared to the 500 ppm dose level. The explanation for this is probably that two opposite effects of bromide on the thyroid exist (activation and inhibition of uptake) (van Leeuwen et al., 1983a). Acute toxicity The acute toxicity to mice and rats is summarized in Table 1. Bromide exerts a very low acute toxicity upon oral administration. Table 1. Acute toxicity of bromide Species Route LD50 Reference Mouse oral 5020 mg/kg bw Vase et al., 1961 Mouse oral 7000 mg/kg bw Graff et al., 1955 Rat oral 3500 mg/kg bw Smith et al., 1925 Short-term toxicity Rats In a range-finding study 5 groups of 4 female Wistar rats received 0, 300, 1200, 4800 or 19200 ppm NaBr (purity 99.5%) for 4 weeks. High dose level rats did not groom themselves sufficiently and showed signs of motor incoordination in their hind legs. No clear influence on growth, food or water intake was observed. At 19200 ppm NaBr, about 50% of the chloride in the plasma, brain, kidneys and liver had been replaced by bromide, while there was no marked influence on the total halogenide concentration. Also in the other treatment groups there was a dose-related replacement of chloride by bromide. Plasma bromide concentration reached a plateau level by the third week of treatment. Relative kidney weight was significantly increased in high dose level rats. Compound related histopathological changes were not observed (van Logten et al., 1973a; 1973b). In another range-finding study, groups of 5 male and 5 female Wistar rats received doses of 0, 75, 300, 1200, 4800 or 19200 ppm NaBr in a low chloride diet (by leaving out NaCl and KCl, but adding 1% potassium sulphate) for 4 weeks. The chloride content was about 3 g/kg, whereas the normal diet contained 11 g/kg. All high dose level rats and 3 male and 2 female rats at 4800 ppm died within 12 and 22 days, respectively. Food intake and growth were significantly decreased at 4800 and 19200 ppm. Kidney weight was significantly increased in males at all dose groups (Kroes et al., 1974). Groups of Wistar-SPF rats (10 animals/sex/group) were fed diets containing 0, 75, 300, 1200, 4800 or 19200 ppm NaBr (purity 99.5%) for 90 days. Grooming was depressed in rats at 19200 ppm NaBr and the animals showed motor incoordination of their hind legs. Body weight gain was significantly decreased in high dose level males during the entire study and in females during the first 6 weeks. Haematological and biochemical parameters were not affected except for an increase in the percentage of neutrophilicranulocytes at 19200 ppm. Relative thyroid weight was significantly increased in male and female rats at 19200 and also in females at 4800 and 1200 ppm. Relative adrenal weight was significantly increased in high dose level male rats and relative testes and prostate weights were significantly decreased at 4800 and 19200 ppm. A significantly decreased thymus weight was observed in high dose level females. Upon histopathological observation, dose-related effects on endocrine organs were found at the two highest dose levels. The thyroid gland showed activation, characterized by a reduction in follicle size along with an increase in the height of the follicular epithelium in the two highest dose groups. In the adrenals, in all dose groups, there was strikingly less vacuolisation of the zona fasciculata, compared with the controls although this was not clearly dose-related. At the highest dose the ovaries showed an indication of a lower number of corpora lutea. In addition, spermatogenesis was decreased in the testes at 19200 ppm and less secretory activity of the prostate was observed (suggesting a diminished production of gonadotropic hormones) at 4800 ppm and 19200 ppm (van Logten et al., 1973; 1974; 1976). Groups of Wistar-SPF rats (10 animals/sex/group) were fed low chloride diets containing 0.4-0.7 g Cl- and 1% potassium sulphate/kg for 90 days. The dose levels were 0, 8, 31, 125, 500 or 2000 ppm NaBr (purity 99.5%), respectively. Observations included body weight, food intake, clinical chemical determinations in blood, urine and liver, bromide and total halogenide in plasma and several organs, organ weights and histopathology. In the highest dose group, 3 male and 3 female rats died during the experiment. At 2000 ppm NaBr grooming was depressed, motor incoordination of the hind legs was observed and the weight gain was significantly decreased. Percentage and total number of neutrophilic granulocytes and the total leucocyte count were increased at the highest dose. Corticosterone in blood was lower at the two highest dose levels (significantly at 2000 ppm). At 2000 ppm the relative weight of heart, brain, spleen, adrenals, thyroid and pituitary gland were increased in males, whereas the relative prostate weight was decreased. In high dose level females, relative heart and brain weight were increased and relative pituitary and uterus weight were decreased. Upon histopathology, in the two highest dose groups activation of the thyroid, absence of nephrocalcinosis in female rats, less vacuolisation in the zona fasciculata of the adrenals and less zymogen granulae in the pancreas were observed. In the highest dose groups, fewer corpora lutea, retardation in maturation of the uterus, inhibition of spermatogenesis and less secretory activity of the salivary glands were observed (van Logten et al., 1976; Rauws et al., 1977). The toxicity of NaBr in rats on a low chloride diet is about 10 times higher, in comparison with the toxicity for rats on a normal diet. The highest dose in the low chloride study (2000 ppm) is more toxic than the highest dose (19200 ppm) in the study for rats on a normal diet (mortality: 6/20 and 1/20 respectively). Observations in humans Since bromide was introduced as a medicine, clinical symptoms of bromide intoxication have been reported. Large doses of bromide cause nausea and vomiting, abdominal pain, coma and paralysis. The chronic state of bromide intoxication is reported as bromism. The signs and symptoms are referable to the nervous system, skin, glandular secretions and gastrointestinal tract (van Leeuwen & Sangster, 1988). Sodium bromide at a dose of 1 mg Br/kg/day was administered orally to 20 healthy volunteers (10 females not using oral contraceptives and not pregnant and 10 males) during 8 weeks. In the females, bromide was administered during 2 full menstrual cycles. Special attention was paid to the endocrine system. The results of the full medical history and physical examination taken at the start and end of the study showed no differences. The measured haematological, biochemical and urine parameters did not change during the experiment. Plasma bromide concentrations rose in females and males from 0.08 + 0.01 mmol/l to 0.97 ± 0.18 mmol/l and from 0.08 ± 0.01 mmol/l to 0.83 ± 0.09 mmol/l, respectively. No changes were observed in the serum concentrations of thyroxine, free thyroxine, thyroxine-binding globulin, triiodothyronine, cortisol, testosterone, estradiol and progesterone. Also no changes were observed in the serum concentration of thyroid-stimulating hormone (TSH), prolactin, luteinizing hormone (LH) and follicle-stimulating hormone (FSH). These hormones were measured before as well as 20 and 60 minutes after the administration of thyrotropin-releasing hormone (TRH) and LH-releasing hormone (LHRH) (Sangster et al., 1981; 1982a). In another study, healthy volunteers were repeatedly given sodium bromide in oral doses of 0, 4 or 9 mg Br/kg/day using a double blind design. Groups of seven males received the treatment for 12 weeks and groups of seven non-pregnant females (not using oral conceptives) over three full cycles. Special attention was paid to possible effects on the endocrine and central nervous systems. At the start and end of the study, a full medical history, the results of physical examination, haematological studies and standard clinical chemistry and urine analyses were recorded for each subject. Except for incidental nausea, no changes were observed. Mean plasma bromide concentrations at the end of treatment were 0.07, 2.14 and 4.30 mmol/l for males and 0.07, 3.05 and 4.93 mmol/l for females of the 0-, 4- and 9-mg Br/kg/day groups, respectively. Only in the females receiving 9 mg Br/kg/day was there a significant increase in serum thyroxine and triiodothyronine at the end of the study compared to pre-administration values, but all concentrations remained within normal limits. No changes were observed in serum concentrations of free thyroxine, thyroxine-binding globulin, cortisol, oestradiol, progesterone or testosterone, or of thyrotropin, prolactin, luteinizing hormone (LH) and follicle-stimulating hormone before or after the administration of thyrotropin-releasing hormone and LH-releasing hormone. Analysis of neurophysiological data (EEG and visual evoked response) showed shifts in the power of various spectral bands and a shift in mean frequency in the groups on 9 mg Br/kg/day. All findings were, however, within normal limits (Sangster et al., 1982b; 1983). A limited replication study was carried out to confirm the findings in the former study. Three groups of 15 females received (double blind) doses of 0, 4 and 9 mg Br/kg/day during three menstrual cycles. After the administration period the 45 females were observed for another three cycles. Mean plasma bromide concentrations at the end of the treatment were 0.07, 3.22 and 7.99 mmol/l, respectively. In none of the three groups were significant changes observed in the serum thyroxine concentration, free thyroxine, triiodothyronine, thyrotropine and thyroxine-binding globulin. Clinical observation did not show effects on the thyroid or on the central nervous system. Quantitative analysis of the electroencephalogram (EEG) showed only a marginal effect in females receiving 9 mg Br/kg/day (Sangster et al., 1986). COMMENTS After oral ingestion bromide is rapidly and completely absorbed in the gastrointestinal tract and distributed almost exclusively in the extracellular fluid. The similarity of bromide to chloride gives rise to an important pharmacokinetic interaction. The two ions compete for reabsorption in the kidney. High chloride reabsorption will lead to higher bromide excretion and vice versa. The biological half-life of bromide can be decreased by administration of chloride. A normal half-life of bromide in the rat of 3 days will increase to 25 days on a chloride-free diet. Bromide exerts various toxicological effects in rats. At high doses effects on the central nervous system were observed. In short-term toxicity studies motor incoordination of the hind legs and inhibition of grooming were found. The main effects of bromide are on endocrine organs. It is assumed that bromide acts directly on organs such as the thyroid, adrenals and testes, thereby inducing alteration in the pituitary gland by feed-back mechanisms. The effect on the thyroid may be explained by interaction with iodide uptake and is the most sensitive effect in animal experiments. In a short-term toxicity study with rats at a normal chloride intake, effects were found on most endocrine organs, while in special studies decreased levels of a number of hormones (thyroxine, growth hormone, testosterone and corticosterone) were observed. On the other hand, TSH and insulin were increased. A NOAEL based upon all available data on the effects on the thyroid of 300 ppm sodium bromide (240 ppm bromide), equivalent to 12 mg bromide/kg bw/day could be established. In a reproduction study in rats, complete infertility was observed at the highest dose level of 19200 ppm sodium bromide whereas at 4800 ppm fertility and viability of the offspring were reduced. At 1200 ppm no effects on reproduction were observed. The effects on fertility were reversible. Bromide was not mutagenic in the Ames test. Studies with sodium bromide in human volunteers did not show neurophysiological or endocrinological changes: the NOAEL was 9 mg bromide/kg bw/day. TOXICOLOGICAL EVALUATION LEVEL CAUSING NO TOXICOLOGICAL EFFECT Rat: 240 ppm, equivalent to 12 mg bromide/kg bw/day Human: 9 mg bromide/kg bw/day ESTIMATE OF ACCEPTABLE DAILY INTAKE FOR MAN 0-1 mg/kg bw REFERENCES Groff, F., Tripod, J. & Meyer, R. 1955. Zur pharmakologischen karakterisierung des Schlafmittels Doriden. Schweiz. med. wschr., 85, 305. Kroes, R., Rauws, A.G., Verhoef, C.H., de Vries, T. & Berkvens, J.M. 1974. Oriënterend toxiciteits onderzoek van het bromide-ion in chloride-arm dieet bij de rat. Report nr. 187 Tox. d.d. december from Rijks Instituut voor de Volksgezondheid. Submitted to WHO by RIVM, Bilthoven, Holland. van Leeuwen, F.X.R., den Tonkelaar, E.M. & van Logten, M.J. 1983a. Toxicity of sodium bromide in rats: effects on endocrine system and reproduction. Fd. chem. toxicol., 21(4), 383-390. van Leeuwen, F.X.R., Loeber, J.G. & Franken, M.A.M. 1983b. Endocrinologisch toxiciteitsonderzoek met natriumbromide. Verslagen adviezen en rapporten 20, 150-153. 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See Also: Toxicological Abbreviations Bromide ion (FAO/PL:1968/M/9/1) Bromide Ion (FAO/PL:1969/M/17/1) Bromide ion (Pesticide residues in food: 1981 evaluations) Bromide Ion (Pesticide residues in food: 1983 evaluations)