Bismuth Toxicity Presenting as Declining  Mobility and Falls

Hogan, David B.; Harbidge, Cathy; Duncan, Amy

doi:10.5770/cgj.21.323

Cited by 15 publications

(11 citation statements)

References 18 publications

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“…FDG-PET brain with diffuse mildly reduced uptake.Marked recovery after withdrawal.Hogan DB. et al (2018) [6]77FLong-term and uninterrupted consumption of bismuth subsalicylate. Impaired balance and gait, tremors and cognitive deficits.Hight urine bismuth levels.Marked recovery 1 month after withdrawal.M: Male; F: Female…”

Section: Discussionmentioning

confidence: 99%

“…Cases of bismuth subsalicylate neurotoxicity reported have been marked by chronic overexposure, high-dose, or both. [6]. Why the disease appears so suddenly in patients with a chronic consumption is a question that cannot be fully answered satisfactorily [13].…”

Section: Discussionmentioning

confidence: 99%

“…Why the disease appears so suddenly in patients with a chronic consumption is a question that cannot be fully answered satisfactorily [13]. Abnormal gut permeability (leading to increased absorption) and renal impairment (with decreased elimination) may predispose to bismuth toxicity [6]. Another theory is that this is not a toxic phenomenon directly proportional to bismuth consumption.…”

Section: Discussionmentioning

confidence: 99%

“…Although usually safe and well tolerated, on long-standing use bismuth salts can cause a reversible syndrome characterized by subacute progression of encephalopathy, myoclonus, lack of coordination, dysarthria, seizures, parkinsonism, and neuropsychiatric symptoms [2–4]. Bismuth subsalicylate (Pepto-Bismol®) appears less likely to cause neurotoxicity than other bismuth compounds (namely bismuth subnitrate or subgallate) [2–6].…”

Section: Introductionmentioning

confidence: 99%

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Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

et al. 2019

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Background: Drugs containing bismuth, although usually safe, may rarely cause neurotoxicity. Case presentation: We describe the case of a 44-year-old woman treated with bismuth subsalicylate for about 20 years, who developed abnormal behaviour and postural instability in two weeks. On examination, she had greyish discoloration of teeth, was confused and presented generalized myoclonic jerks. In the next days, her clinical condition deteriorated, with a reduction in alertness and more exuberant myoclonus. Brain MRI was unremarkable. CSF revealed mild elevation of protein content (47 mg/dL; reference range: 15-45 mg/dL) and elevation of white blood cell count (10/μL). Bismuth levels in urine (375 μg/L), serum (260 μg/L) and CSF (21.4 μg/L) samples were highly above the threshold for toxicity. Following supportive treatment and bismuth discontinuation, she made a full recovery within weeks. Conclusions: Although rare, bismuth encephalopathy should be considered in patients presenting with subacute encephalopathy and myoclonus. This encephalopathy can be subacute even after a chronic exposure. Cessation of bismuth can lead to a complete resolution in weeks.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

et al. 2019

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“…Furthermore, excipients in current formulations include heavy metal salts such as bismuth subnitrate [ 14 , 15 , 16 , 17 , 18 ] aluminum monostearate and mineral oils, for which there is information on their undesirable effect on cells and tissues that they contact. For example, bismuth subnitrate has been shown to induce neurotoxic effects in both humans and animals [ 19 ] with reported side effects being encephalopathy, nephropathy, stomatitis and colitis [ 20 ].…”

Section: Introductionmentioning

confidence: 99%

On the Biocompatibility and Teat Retention of In Situ Gelling Intramammary Formulations: Cattle Mastitis Prevention and Treatment

Bhattarai

Perumal

Rathbone³

et al. 2021

Pharmaceutics

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Treatment and prevention of cattle mastitis remains a formidable challenge due to the anatomical and physiological constraints of the cow udder. In this study, we investigated polymeric excipients and solvents that can form, (when combined) novel, non-toxic and biocompatible in situ gelling formulations in the mammary gland of bovine cattle. We also report on a new approach to screen intramammary formulations using fresh excised cow teats. Fourteen hydrophilic polymers and six solvents were evaluated for in vitro cytotoxicity and biocompatibility towards cultured bovine mammary epithelial cells (MAC-T), microscopic and macroscopic examination upon contact with excised cow teats. No significant cytotoxicity (p > 0.05) was observed with polyethylene oxides, hydroxypropyl methylcellulose, carboxymethyl cellulose, sodium alginate and xanthan gum. Polycarbophil and carbopol polymers showed significantly higher cytotoxicity (p < 0.05). Concentration-dependent cytotoxicity was observed for glycerin, propylene glycol, polyethylene glycol 400, ethanol, N-methyl-2-pyrrolidone and 2-pyrrolidone, with the 2-pyrrolidone solvents showing higher cytotoxic effects (p < 0.05). In situ gelling formulations comprising hydroxypropyl methylcellulose or carboxymethyl cellulose and solvents in specific ratios were biocompatible at higher concentrations with MAC-T cells compared to alginates. All investigated formulations could undergo in situ sol-to-gel phase transformation, forming non-toxic gels with good biocompatibility in excised cow teats hence, showing potential for use as intramammary carriers for sustained drug delivery.

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Effectiveness of Non-Budesonide Therapies in Management of Microscopic Colitis: A Systematic Review and Meta-analysis

Rehde,

Hendel,

Juhl

et al. 2023

Drugs

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Bismuth Toxicity Presenting as Declining Mobility and Falls

Cited by 15 publications

References 18 publications

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

Bismuth encephalopathy- a rare complication of long-standing use of bismuth subsalicylate

On the Biocompatibility and Teat Retention of In Situ Gelling Intramammary Formulations: Cattle Mastitis Prevention and Treatment

Effectiveness of Non-Budesonide Therapies in Management of Microscopic Colitis: A Systematic Review and Meta-analysis

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