Bismuth Toxicity Masquerading as Alzheimer's Dementia

ABSTRACT: A 76-year old white married female had rapid onset dementia with myoclonus and was admitted to an HMO hospital where she was initially diagnosed as Alzheimer's disease. The physician­husband suggested that th..: condition might be due La the Pepto-BismoJ which she had taken chronically to control her irritable bowel syndrome. An elevated serum bismuth level of 242 flg/L (nonnal is 5 !J.g/L) established bismuth toxicity as the cause of the dementia. With treatment the patient returned to a normal mental state encephalopathy needs differential diagnosis dementia. The to of possibility be considered possible of Alzbismuth in the heimer's INTRODUCTION Bismuth was used in medicinal salves as early as J 713 and internally for treatment of spasmod ic bowels by the 1790s. Bismuth preparations are generally considered very safe and are often taken without knowledge of possible, albeit rare, neurotoxicity. Bierer's review of bismuth subsalicylate [Pepto-Bismol] states that there have been no cases of neurotoxicity in the United States (1). However, Gordon el al. reported a case of a 54-year old man with suspected bismuth encephalopathy who had taken between 4-16 oz of Pepto-Sismol per day (1.04-4.16 mg/day of