Bismuth Subgallate Toxicity in the Age of Online Supplement Use

Paul Sampognaro, Kathy T. Vo, Megan Richie, Paul D. Blanc, Kevin Keenan

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


Introduction: Bismuth salts have been used to treat gastroenterological disorders and are readily available over-the-counter and via the internet. Even though generally considered safe, bismuth compounds can cause a syndrome of subacute, progressive encephalopathy when taken in large quantities. Case Report: We present the case of woman who developed progressive encephalopathy, aphasia, myoclonus, and gait instability after chronically ingesting large amounts of bismuth subgallate purchased from a major online marketing website to control symptoms of irritable bowel syndrome. After extensive neurological work-up, elevated bismuth levels in her blood, urine, and cerebrospinal fluid confirmed the diagnosis of bismuth-related neurotoxicity. She improved slowly following cessation of exposure. Conclusion: This case highlights bismuth subgallate as a neurotoxic bismuth formulation and reminds providers of the potential for safety misconceptions of positively reviewed online supplements.

Original languageEnglish (US)
Pages (from-to)237-240
Number of pages4
Issue number6
StatePublished - Jan 1 2017
Externally publishedYes


  • Key Words: Bismuth
  • subgallate
  • supplements

ASJC Scopus subject areas

  • Clinical Neurology


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