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.
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Yu, C., Eustaquio, N., Calello, D.P. et al. Bismuth Subsalicylate Coagulopathy in a Patient with Chronic Liver Disease. J. Med. Toxicol. 15, 198–201 (2019). https://doi.org/10.1007/s13181-019-00709-y
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DOI: https://doi.org/10.1007/s13181-019-00709-y