Transcription
AJ is a 38-year-old man, presenting to the emergency room with psychosis. The admitting nurse offered him a glass of water. He refused, telling them that he distills his own water at home, because he believes that his neighbor is poisoning him. He wanted everyone to know that he studied nutrition in college.
3 months earlier, AJ was browsing the most informative website on the entire internet, reading about health. He saw a post discussing how table salt, sodium chloride, is bad for you. And he didn't like this. In… the real world… if something is unavoidable in daily life, like salt, then being mindful of your intake, and actually using it sparingly, is the best way to “limit the bad effects.” That’s the actual sentiment one will find when reading through the medical literature on this, but, AJ didn’t like that answer. HE studied nutrition in college, so it was time for him to find a better answer.
AJ started arguing with people on the internet. He got the idea in his mind that chloride is the cause of all the health problems rather than sodium. It’s almost as abundant in blood as sodium is. So if one were to reduce chloride intake, then, clearly, it will be better for health. And why argue with stupid people on the internet, AJ thought. AI is smart. It’s all signal no noise. When he started chatting with it, the AI reaffirmed him. “You are correct!” “Ah— good question!” It said that Sodium Bromide was a viable alternative to Sodium Chloride, but it asked him about his goals. If the goal is reducing chloride for health, you could avoid chlorine compounds in bleach or in the pool. You could replace chlorine-based cleaning and disinfecting agents too. When you get to this extreme side of the periodic table, elements aren’t REALLY that different, because right next to them, are the noble gases. These are stable and they don’t react, so definitely there’s no problem… For cleaning. But AJ glazed over that cleaning detail. It was time to clean his body of chloride.
He ordered sodium bromide online, and started using it to salt everything that he ate. At first, AJ didn’t really notice too much of a difference. It definitely didn’t taste the same. But it wasn’t bad. And as the days continued, he FELT he was getting healthier. But then he started getting thirsty. He noticed this when he felt his stomach suddenly cramp up. Muscles cramp up because of dehydration, so as long as he was hydrating, it was no problem, he thought. But everyday, in the morning, water would come up. He’d feel exhausted after this. There were hours where he was watching TV. But he didn’t have a TV. He started having a headache that wouldn’t go away. He lived alone but could hear someone talking to him. His new upstairs neighbor would non-stop drag things across the floor. The ceiling would vibrate, and he knew he could see paint chips flake from the ceiling, and drop into his water. The voice that was speaking to him said that that neighbor was doing this on purpose to poison him. But the voice and the neighbor kept getting louder and louder and when he finally couldn’t take this anymore he brought himself to the emergency room where we are now.
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At examination, doctors do a blood test and immediately find that AJ has hyperchloremia. Hyper meaning high. Chlor referring to chloride. And -emia meaning presence in blood. High chloride presence in blood. But how could this be? AJ eliminated chloride from his diet and replaced it with bromide instead. How is it possible that he has high chloride presence in blood? Well, there’s a little chemistry to be known here. Chloride has a negative electrical charge. When hospital labs measure it, they use a device that finds the movement of chloride ion through a membrane. The problem is, these devices assume that you’re measuring chloride, because it’s the only negatively charged, simple, elemental ion that’s supposed to be in your body. So if there’s another negatively charged, simple, elemental ion in the body like bromide, in a significant amount, the reported number is going to include bromide, and lump everything together for a giant number. The AI chatbot was right. Bromide isn’t that different from chloride. AJ doesn’t actually have high chloride presence in blood. What’s actually being measured as chloride, is really bromide. It’s in his blood, it’s accumulated in his body. But nothing will tell doctors that it’s bromide. They don’t know that he took it. He’s so incapacitated that he can’t tell them that. But, hyperchloremia with paranoid delusions gives them some clues as to what’s happening.
Humans are electrically neutral. We’re not charged. So our negative and positive charges are equal in the body. We just said that there aren’t that many different negatively charged things in the body. Chloride is one, and it’s the most abundant one in the blood. And Bicarbonate, which is base, is the second largest one, it’s there to balance out Acid. Some proteins and fats are negatively charged, but we don’t need to figure out every single one. If we can get a rough calculation, based on the most common body ions, and we can repeat that measurement, while a patient is in the hospital, then just the changes in that calculation can give us insight on what’s happening. Sodium is the majority of positive ion in the blood. It’s more than 90%. So if chloride and bicarbonate are the most abundant negative ions, at 85%, then, in a healthy person, if you subtract chloride and bicarbonate negative charge from sodium positive charge, you get between 4 and 12. This is called the anion gap, anion being a negatively charged chemical. 90 versus 85 percent means this difference should always be positive. If it’s negative, something is wrong. And in AJ, it was negative. His hyperchloremia was so high, that his anion gap was -21. These 3 numbers tell us a lot. He had excessive thirst. That could mean that he was dehydrated. But think about that. Less water would mean that his sodium would be high. But it wasn’t. It was normal. He had a little bit more base in his body than normal too. This could be a problem, maybe not. All of this information, together with psychotic symptoms, tells the medical team that the chloride measurement is simply wrong. And that the only thing that could cause that, is AJ taking too much bromide for whatever reason because of where it is on the periodic table next to chloride.
In the psychiatric unit, the nurse saw that AJ had tried to escape. AJ told them he was seeing shadowy figures and hearing voices. And there’s a medical reason why bromide does this. Bromide used to be a treatment for seizures. In 1857, Dr Charles Locock in Victorian England was looking to treat a group of women’s excessive libido, and “uncontrollable onanism.” They believed that back then, that if you engaged in that self behavior, it would cause seizures. Only one of the women in this group actually had epilepsy, but the bromide did in fact, suppress her seizures. And bromide was being used for this all the way into the 1970s, just the seizure part. And when it was banned by the FDA, that was when it stopped. And the reason for the ban wasn’t because companies were paying off the FDA. The alternatives for seizure treatments were already 60 and 40 years old at that time, and were off patent. It was because bromide side effects were really difficult to deal with.
The AI that AJ chatted with, got caught between the blurred lines. Bromide and Chloride, physically, get mistaken as the same thing. The lab blood test does it. The human body does it too. They’re not the same thing. And that’s the problem. Let’s start with the brain. There’s 2 different modes. It gets excited. And it gets inhibited. Excitation happens through a neurotransmitter called glutamate. And inhibition happens through a neurotransmitter called GABA. When GABA calms the brain down, the brain cells let chloride rush in to send the signal to other cells and nerves. But if bromide is there, the body can’t tell the difference. It’s not the same thing. When bromide is surrounded by water, the total size is smaller than when chloride is surrounded by water. This means that more bromide enters into the brain than chloride, sending a more intense signal. Altering GABA in the brain leads to a variety of problems in a way that we are still learning about. For example, Alcohol is a depressant. It does that, through GABA. When one becomes dependent on alcohol, the brain compensates in the opposite direction, creating more structures that excite the brain, because it’s always inhibited by the alcohol. And that person suddenly quits cold turkey, the brain, expecting more alcohol to calm it, starts to hallucinate. It becomes paranoid. It causes seizures, and the resulting discharge can be deadly. For AJ, bromide was acting on GABA in his brain causing the delusional thinking and psychosis. We also know that Bromide substantially lowers blood flow to certain parts of the brain. Muscles use chloride to signal for contraction. But bromide is too similar while being different enough. The muscles in his gut became irritated, causing severe nausea, and the movement up would somewhat limit the amount that would absorb into his body. But only until he would eat more sodium bromide at his next meal. The kidneys exchange ions to make urine. The electric gradient helps concentrate water from the blood. But when the wrong ions are present, the wrong urine is made. And eventually, chloride is so depleted in his body, that it’s bromide left. And it’s there to cause more problems. It caused him to have a skin rash and acne that he had never had before.
Luckily the medical team were able to determine this quickly because of the “hyperchloremia” in his blood test. If chloride was displaced by his bromide intake, then the answer would be to give him chloride to replenish the stores, and displace all the bromide absorbed in his body. You keep giving it until the bromide is gone. He was started on an aggressive IV with the exact chemical that caused him to do all of this: sodium chloride, because that’s what our bodies are made of. It’s interesting that this first, most-visibly recorded case of someone taking health-influence from AI, and getting hospitalized, is bromism. This is a problem that should have disappeared in America, because the FDA banned bromide in all but a few medicines. But occasionally, it surfaces.
There’s some people, who might drink a lot of Robitussin. Sometimes for cough, sometimes not. Don’t do the latter. You’ll notice that Robitussin is Dextromethorphan HBr, which is hydrobromide, done this way because bromide does suppress cough. So on top of the actual cough syrup causing psychotic symptoms when taken inappropriately, the bromide adds on top of it. In 1997 a man drank a gallon of soda everyday. As late as 2014, in the United States, brominated vegetable oil was used in some sodas to give off the cloudy, opaque appearance. The man had symptoms of headache, fatigue, and memory loss, similar to AJ because his blood bromide levels were measured to be similar to that of AJ’s. Although, it’s still a little unclear today how this happened specifically to him because I think we all know people who drink as much, if not more soda than that, even before the elimination of brominated vegetable oil from soda in the United States. More recently, there were cases of bromism coming from dietary supplements reported in literature, all with the same confusion, agitation, psychiatric and gastrointestinal symptoms that AJ had.
In the hospital, AJ started to improve over days on the sodium chloride IV. He was well enough to be able to tell the medical team about strange zits he started growing all over his body, and how he had been so tired before he arrived at the hospital. All of these gave doctors more clues to the medical team that he did have bromism, as a blood test specifically for bromide arrives back from the lab to confirm what happened. It’s ironic that the human brain and an artificial brain both regarded chloride and bromide as interchangeable. Before the AI safeguards were hard-coded in. A currently obscure, but historically prominent, narrowly-similar-to-normal-function, elemental poisoning had all the features of something that would slip through the cracks and cause a real problem. But, was this really an AI problem, or was it a people problem?
I had a conversation with ChatGPT 5 about this, in November 2025. This case was all over the news in August 2025 when the case report was published in the Annals of Internal Medicine. Clearly once the media storm of this case had come out, someone working on ChatGPT had patched it up. Gratuitously. There was a specific bromide warning every time you brought up chloride. And when pressed about it, the AI uncharacteristically became defensive. I’ve never seen a commercial chatbot push back like this, because in the end, this is a product. If something is going to disagree all the time and just be nasty, no one’s going to want to use that. Why pay to be yelled at when I get that for free everyday? But even worse, when I replied back “so why did that guy end up taking bromide?” the AI even said “there isn’t actually any ‘guy’— no real person in a prior conversation took bromide because of me.” Which when asked further, the chatbot did fold and admit there was a person, but then went back to be reinforcing, with some really weird wordsmithing. It liked to say that “I do not recommend sodium bromide” but that someone did take sodium bromide after consulting ChatGPT. As if “I” and “ChatGPT,” are 2 different entities when speaking. These chatbot models change multiple times per day. It’s inconsistent. One answer one day. Another answer on a different day. Some days it’s good, other days it sucks.
But this is where the bigger question comes in. In the paper this case is based on, and in news articles that were published around the same time, it really does look like the patient got his own ideas and only paid attention to what he wanted to pay attention to. That’s a human problem, it’s not an AI problem. Granted, AI maybe could have done a little bit better of a job to flash giant obnoxious warnings like it does now. But if you’ve been alive long enough, you should know people. Sign is literally in their face and they still miss what it says. That ChatGPT brought up Sodium Bromide as a substitute to Sodium Chloride in the context of cleaning and other outside-of-the-body uses wasn’t wrong. All of the articles about this case mention this. It’s maybe a little bit of a weird communication back. But have you ever talked with someone else, and it just seems like they don’t know what you’re talking about? But sometimes, it feels like they dont even want to try to understand what you’re saying? No one has seen this patient’s actual logs with ChatGPT, but this seems to be the most plausible thing that the program said. And at the end of the day, ChatGPT didn’t hold this guy down and force feed bromide into his mouth. Just like every other technology from the last 100 years, generative AI amplifies people, both good and bad. AI is going to keep needing to find new places to put warnings after every new accident, because people always manage to find new ways to mess things up. And the new ways, look just like the old ways, bringing us back to bromide.
At 3 weeks of hospitalization AJ’s anion gap became normal and his psychotic symptoms improved. The time that it takes for the amount of bromide in the body to cut in half is 12 days. This means after 24 days, little more than 3 weeks, 2 half-lives, the amount in his body was one quarter the amount when he presented to the emergency room. Bromide is not acutely deadly. But the onset of symptoms is insidious. The problems that it causes adds up over time with continued intake. And the person the psychotic symptoms are happening to, appear gradually and they don’t realize that it’s happening. But this level was good enough for him to be able to go home as he was able to make a full recovery.
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