Chronic oral intake of bismuth salts can result in a potentially reversible encephalopathy.
Clinical findings - prodromal:
(1) asthenia
(2) somnolent
(3) depressed
(4) delusions
(5) hallucinations
(6) disturbed speech
(7) difficulty writing
Clinical findings - encephalopathy:
(1) confusion that may progress to dementia
(2) altered mental status that may progress to coma
(3) dysarthria
(4) difficulty standing or walking
(5) pseudotremor with myoclonic jerks
Additional findings:
(1) bluish bismuth line on the gums
Laboratory findings:
(1) high levels of bismuth in the blood (> 20 times the upper limit of normal)
The encephalopathy is reversible if intake of the bismuth salts is stopped.
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Specialty: Toxicology, Emergency Medicine, Critical Care
