Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease

Catherine Yu, Noel Eustaquio, Diane Calello, Bruce E. Ruck, Lewis S. Nelson, Cynthia Santos

Research output: Contribution to journalArticle

Abstract

Bismuth subsalicylate (BSS) is the active ingredient in over-the-counter antacid and antidiarrheal medications. Coagulopathy in the setting of acetylsalicylic acid toxicity is well documented but not in setting of bismuth subsalicylate overuse. We present a case report of coagulopathy from BSS poisoning in a patient with underlying cirrhosis. The patient’s high prothrombin time suggests inhibition of vitamin K-dependent coagulation factors. The patient had decreased factor V activity, which is responsible for converting prothrombin to thrombin. Patients with cirrhosis often have hypoprothrombinemia which may be exacerbated by salicylate-induced coagulopathy. Given the widespread use of BSS products, physicians should recognize coagulopathy as a possible manifestation of toxicity especially in patients with underlying liver disease.

Original languageEnglish (US)
Pages (from-to)198-201
Number of pages4
JournalJournal of Medical Toxicology
Volume15
Issue number3
DOIs
StatePublished - Jul 15 2019

Fingerprint

Liver
Liver Diseases
Chronic Disease
Prothrombin
Toxicity
Antidiarrheals
Fibrosis
Antacids
Hypoprothrombinemias
Blood Coagulation Factors
Vitamin K
Salicylates
Thrombin
Aspirin
Prothrombin Time
Poisoning
bismuth subsalicylate
Physicians

All Science Journal Classification (ASJC) codes

  • Health, Toxicology and Mutagenesis
  • Toxicology

Keywords

  • Bismuth
  • Coagulopathy
  • Liver disease
  • Salicylate

Cite this

Yu, Catherine ; Eustaquio, Noel ; Calello, Diane ; Ruck, Bruce E. ; Nelson, Lewis S. ; Santos, Cynthia. / Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease. In: Journal of Medical Toxicology. 2019 ; Vol. 15, No. 3. pp. 198-201.
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Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease. / Yu, Catherine; Eustaquio, Noel; Calello, Diane; Ruck, Bruce E.; Nelson, Lewis S.; Santos, Cynthia.

In: Journal of Medical Toxicology, Vol. 15, No. 3, 15.07.2019, p. 198-201.

Research output: Contribution to journalArticle

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