{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T02:54:37Z","timestamp":1769914477504,"version":"3.49.0"},"reference-count":11,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2020,10,30]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>A 79-year-old man presented to the emergency department with a 1-week history of worsening confusion, falls and hearing impairment. An initial workup for infectious, metabolic and structural causes was unrevealing. However, further history discovered that he had been ingesting one to two bottles of Pepto-Bismol (bismuth subsalicylate) daily for gastro-oesophageal reflux symptoms. On his second day of admission, the plasma salicylate concentration was 2.08 mmol\/L (reference range 1.10\u20132.20 mmol\/L), despite no sources of salicylate in hospital. He was diagnosed with chronic salicylate toxicity and Pepto-Bismol use was discontinued. The patient was treated supportively with isotonic intravenous fluids only and plasma salicylate concentration fell to less than 0.36\u2009mmol\/L. Concurrently, all his symptoms resolved. This case highlights the potential adverse effects of over-the-counter medications. The diagnosis of chronic salicylate toxicity is challenging, specifically in the elderly and in undifferentiated presentations, as it can be missed if not suspected.<\/jats:p>","DOI":"10.1136\/bcr-2020-236929","type":"journal-article","created":{"date-parts":[[2020,11,30]],"date-time":"2020-11-30T15:46:25Z","timestamp":1606751185000},"page":"e236929","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Salicylate toxicity from chronic bismuth subsalicylate use"],"prefix":"10.1136","volume":"13","author":[{"given":"Sheliza","family":"Halani","sequence":"first","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter E","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of Clinical Pharmacology and Toxicology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"Division of General Internal Medicine and Geriatrics, University Health Network, Toronto, Ontario, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2020,11,30]]},"reference":[{"key":"2025082623422866000_13.11.e236929.1","doi-asserted-by":"crossref","first-page":"91","DOI":"10.4103\/0976-500X.110872","article-title":"Adverse drug reactions in the elderly","volume":"4","author":"Brahma","year":"2013","journal-title":"J Pharmacol Pharmacother"},{"key":"2025082623422866000_13.11.e236929.2","doi-asserted-by":"crossref","first-page":"2867","DOI":"10.1001\/jama.2008.892","article-title":"Use of prescription and over-the-counter medications and dietary supplements among older adults in the United States","volume":"300","author":"Qato","year":"2008","journal-title":"JAMA - J Am Med Assoc"},{"key":"2025082623422866000_13.11.e236929.3","doi-asserted-by":"publisher","DOI":"10.3810\/pgm.2009.07.2041"},{"key":"2025082623422866000_13.11.e236929.4","doi-asserted-by":"crossref","first-page":"48","DOI":"10.3390\/medicines4030048","article-title":"Salicylate poisoning potential of topical pain relief agents: from age old remedies to engineered smart patches","volume":"4","author":"Anderson","year":"2017","journal-title":"Medicines"},{"key":"2025082623422866000_13.11.e236929.5","doi-asserted-by":"crossref","first-page":"576","DOI":"10.1111\/jpc.13861","article-title":"Chronic use of teething gel causing salicylate toxicity","volume":"54","author":"Nguyen","year":"2018","journal-title":"J Paediatr Child Health"},{"key":"2025082623422866000_13.11.e236929.6","doi-asserted-by":"publisher","DOI":"10.2165\/00002512-199101010-00008"},{"key":"2025082623422866000_13.11.e236929.7","doi-asserted-by":"crossref","first-page":"308","DOI":"10.1016\/0002-9343(94)90017-5","article-title":"Chronic salicylate toxicity due to consumption of over-the-counter bismuth subsalicylate","volume":"97","author":"Vernace","year":"1994","journal-title":"Am J Med"},{"key":"2025082623422866000_13.11.e236929.8","unstructured":"Lugassy DM . Salicylates. In: Nelson LS , Howland MA , Lewin NA , et al , eds. Goldfrank's toxicologic emergencies. 10th edn. 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