Bismuth Absorption and Myoclonic Encephalopathy during Bismuth Subsalicylate Therapy
Authors: Paul C. Mendelowitz
Journal: Annals of Internal Medicine (1990)

Brief Reports15 January 1990Bismuth Absorption and Myoclonic Encephalopathy during Bismuth Subsalicylate TherapyPaul C. Mendelowitz, MD, Robert S. Hoffman, MD, Scott Weber, MDPaul C. Mendelowitz, MDSearch for more papers by this author, Robert S. Hoffman, MDSearch for more papers by this author, Scott Weber, MDSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-112-2-140 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptA 45-year-old man with the acquired immunodeficiency syndrome (AIDS) was hospitalized for dehydration and syncope after 7 days of watery diarrhea. Three weeks earlier he had been hospitalized with Pneumocystis carinii pneumonia and treated with a 14-day course of trimethoprim and sulfamethoxazole with excellent response. Shortly after completing his therapy he developed watery diarrhea consisting of 10 to 15 stools per day. Stool specimens were negative for enteric pathogens, ova and parasites, Isospora belli, Cryptosporidium, Mycobacterium avium-intracellulare, and Clostridia difficile toxin.Therapy consisted of fluid and electrolyte replacement, intravenous alimentation, and zidovudine (200 mg orally every 4 hours). A rectal...References1. Winship K. Toxicity of bismuth salts. Adverse Drug Reactions and Acute Poisoning Reviews. 1983;2:103-21. Google Scholar2. Pickering L, Feldman S, Ericsson C, and Cleary T. Absorption of salicylate and bismuth from a bismuth subsalicylate-containing compound (Pepto-Bismol). J Pediatr. 1981;99:654-6. CrossrefMedlineGoogle Scholar3. Hillemand P, Palliere M, Laquais B, and Bouvet P. Bismuth treatment and blood bismuth levels. Sem Hop Paris. 1977;53:1663-9. MedlineGoogle Scholar4. Spoerke D. Bismuth. In: Poisondex Substance Identification, v 55. Denver: Micromedex Inc.; 1988. Google Scholar5. Burns R, Thomas D, and Barron V. Reversible encephalopathy possiblyassociated with bismuth subgallate ingestion. Br Med J 1974;1:220-3. CrossrefMedlineGoogle Scholar6. Supino-Viterbo V, Sicard C, Risvegliato M, Rancurel G, and Buge A. Toxic encephalopathy due to ingestion of bismuth salts: clinical and EEG studies of 45 patients. J Neurol Neurosurg Psychiatry. 1977;40:748-52. CrossrefMedlineGoogle Scholar7. Hasking G and Duggan J. Encephalopathy from bismuth subsalicylate [Letter]. Med J Aust. 1982;2:167. CrossrefMedlineGoogle Scholar8. Pearson A, Eastham E, Laker M, Craft A, and Nelson R. Intestinal permeability in children with Crohn's disease and coeliac disease. Br Med J. 1982;285:20-1. CrossrefMedlineGoogle Scholar9. Hollander D, Vadheim C, and Brettholz E. Increased intestinal permeability in patients with Crohn's disease and their relatives. Ann Intern Med. 1986;105:883-5. LinkGoogle Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAuthors: Paul C. Mendelowitz, MD; Robert S. Hoffman, MD; Scott Weber, MDFrom Presbyterian Hospital and The New York City Poison Control Center, New York, New York. For current author addresses, see end of text. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byIs Bismuth Really the “Green” Metal? 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