Table 1.
Summary of neurotoxicity cases from ingestion of bismuth subsalicylate
| Reference | Age | Sex | Bismuth Dose | Bismuth Duration | Manifestations | Bismuth Level and Outcome |
|---|---|---|---|---|---|---|
| Hasking & Duggan (1982)(13) | 60 | M | Unknown | “… some years” | Withdrawn, inappropriate & twitching x mth then dysarthria, disorientation, incontinence x2, twitches & primitive reflexes | High blood level; full recovery in mth |
| Mendelowitz et al. (1990)(14) | 45 | M | 5.2–9.4 g/d (AIDS patient with diarrhea(24) | 7 days | Lethargy, dysarthria, & myoclonic jerking that progressed to coma with myoclonus | High blood & urine levels; death |
| Jungreis & Schaumburg (1993)(15) | 68 | F | 1.2 g/d | 2 yrs | Intention/rest tremor, myoclonic jerks, unsteady gait, forgetfulness & episodic confusion | Blood level high 6 wks after stopping; recovery in 6 mths |
| Gordon et al. (1995)(16) | 54 | M | 1–4 g/d with recent increase | Took for “… many years” | Progressive confusion, memory difficulty, myoclonic jerks, tremor & unsteady gait | Blood & urine levels high 35 days after stopping; improved over 12 wks |
| Reynolds et al. (2012)(17) | 56 | F | 2.3 g/d with recent increase | 2 mths | Psychomotor retardation, poor concentration, drowsy, visual hallucinations, tremor, myoclonic jerks, & postural instability | High blood & urine levels; recovery within several mths |
| Masannat & Nazer (2013)(18) | 56 | F | 2.3 g/d | Unclear (abstract stated mths but text indicates several wks) | Progressive confusion, poor concentration, myoclonic jerks, tremors, gait instability, and visual hallucinations | High blood level days after stopping; complete recovery in 4 mths |
| Siram et al. (2017)(19) | 25 | F | Unclear but high dose – 8 tablets Q2 hr. | 15–20 days | Tinnitus/hearing loss (likely concurrent salicylate toxicity) progressing to altered sensorium | Elevated blood level 20 d after stopping; improved over 2 mths |
M = Male; F = Female.