Bismuth Subgallate Toxicity in the Age of Online Supplement Use.

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Sampognaro P, Vo KT, Richie M, Blanc PD, Keenan K

Bismuth Subgallate Toxicity in the Age of Online Supplement Use.

Neurologist. 2017 Nov;22(6):237-240. doi: 10.1097/NRL.0000000000000144.

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29095326 [ View in PubMed
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Abstract

INTRODUCTION: Bismuth salts have been used to treat gastroenterological disorders and are readily available over-the-counter and via the internet. Even though generally considered safe, bismuth compounds can cause a syndrome of subacute, progressive encephalopathy when taken in large quantities. CASE REPORT: We present the case of woman who developed progressive encephalopathy, aphasia, myoclonus, and gait instability after chronically ingesting large amounts of bismuth subgallate purchased from a major online marketing website to control symptoms of irritable bowel syndrome. After extensive neurological work-up, elevated bismuth levels in her blood, urine, and cerebrospinal fluid confirmed the diagnosis of bismuth-related neurotoxicity. She improved slowly following cessation of exposure. CONCLUSION: This case highlights bismuth subgallate as a neurotoxic bismuth formulation and reminds providers of the potential for safety misconceptions of positively reviewed online supplements.

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